Pulmonology

Pulmonary-specialist health coach increased guideline-based care and symptom outcomes in low-income adults.

In a 16-week randomized trial of low-income English- or Spanish-speaking adults with asthma and/or COPD, a lay health coach plus remote pulmonary specialist review increased guideline-based care delivery (intervention 165 vs control 163; RR 1.61). The intervention also increased chronic lung disease education and improved breathing-related quality of life, symptoms, and patient-rated quality of care. There was no pooled increase in guideline-based medication use on the planned analysis, though a post-hoc arm-specific baseline analysis suggested improvement. This model is scalable to resource-limited primary care but requires workflows linking coaches, specialists, and primary clinicians for implementation. 1

Tezepelumab reduced exacerbations and improved FEV1 across phenotypes in diverse real-world severe asthma.

In the 12-month, single-arm PASSAGE study of 286 US patients with severe uncontrolled asthma, annualized exacerbations fell from 2.88 to 0.87 per year (70% reduction). Pre-bronchodilator FEV1 increased by 0.122 L overall and by 0.212 L in patients with baseline FEV1 ≤80% predicted. Clinically meaningful improvements in asthma control and quality-of-life measures occurred in 51–91% across phenotypes and underrepresented groups. No new safety signals were identified, supporting real-world effectiveness across eosinophil, allergic, and historically underrepresented subgroups. 2

Fan therapy yields short-term dyspnea relief but no consistent physiological benefit.

This systematic review of 15 trials (623 participants) found no overall dyspnea severity improvement, but a post-hoc analysis showed short-term relief within 5–10 minutes (SMD -0.41). No consistent effects were seen on physiological parameters, activity levels, or self-efficacy. Qualitative data report high acceptability among patients, clinicians, and caregivers, and low cost and portability support bedside or home use. Recommend fan therapy as an adjunct for rapid symptom relief, recognizing limited sustained benefit and need for longer trials. 3