Seeking U.S.-based experts in pulmonology to comment on innovations in COPD and asthma care I am working on a Medscape article about new approaches to managing COPD and asthma that go beyond standard inhaler therapy. I am seeking U.S.-based pulmonologists, researchers, or physicians with experience in pulmonary medicine to share insights on emerging strategies in clinical practice and research. Questions: What innovations in COPD and asthma care are you seeing beyond pharmacotherapy (e.g., breathing techniques, pulmonary rehab, personalized approaches)? Are you using or researching personalized oxygen protocols? If so, how do they compare with standard oxygen therapy? What role do biologic or precision-medicine therapies play in COPD and asthma management today? What barriers exist in implementing these newer approaches (cost, access, adherence)? How can primary care providers best incorporate or refer for these innovations? Looking ahead, what developments are most promising for improving COPD and asthma outcomes over the next 5 years? Consent Note: By responding, you consent to being quoted in a Medscape article with attribution. Quotes may be lightly edited for clarity, style, and flow. Please disclose any potential conflicts of interest (such as financial relationships with relevant companies or organizations).

Good Day, Innovations beyond pharmacotherapy: We personalize approaches like pulmonary rehabilitation and breathing techniques such as pursed-lip and diaphragmatic breathing, going beyond pharmacotherapy for symptomatic relief and increased pulmonary function. Rehab tailored to patient-specific factors will eventually become a standard intervention in lifestyle changes. Personalized oxygen protocols: Real-time monitoring personalized adjustments of flow levels in oxygen therapy at the individual level is still a promise in refining the use of oxygen and life quality improvements on a scale compared to set regimes, but certainly much more data are still needed. The place of biologics and precision medicine: Biologics transform significant asthma management to targeting very specific inflammatory pathways for intervention. The recognition of subgroups such as eosinophilic patients in COPD makes individual treatment much more precise, but this area is still growing. Barriers to Implementation: High costs, scant insurance coverage, geographic access, adherence, and education hurdles remain large barriers. Many providers also may not be trained and/or resourced adequately for the new aspects of care. Integration into primary care: Early detection and referral come from primary care providers. Simple symptom tracking, patient teaching on breathing techniques, and easygoing channels to specialists or rehab programs are also vital. Promising developments: Digital health-remote monitoring, novel biologics, and advanced oxygen delivery systems have the power to rise above all other advances in the next 5 years and improve patient outcomes. If you decide to use this quote, I'd love to stay connected! Feel free to reach me at gregorygasic@vmedx.com and outreach@vmedx.com.

Emerging strategies for managing COPD and asthma are expanding well beyond inhaler therapy, offering new options that target symptoms, quality of life, and long-term health outcomes. Pulmonary rehabilitation is one of the most effective non-pharmacologic approaches and is increasingly available in telehealth formats to overcome barriers of access. Breathing retraining and inspiratory muscle training can further support exercise tolerance and reduce dyspnea. Device-based interventions are advancing, including bronchoscopic lung volume reduction with one-way valves. In asthma, bronchial thermoplasty continues to provide reliable improvements in severe disease for select patients. Personalized oxygen therapy is another evolving area. While long-term oxygen remains strongly recommended for severe chronic resting hypoxemia, large trials show no benefit for moderate desaturation, prompting more selective prescribing. This encourages clinicians to tailor oxygen flow to exertional testing, symptom relief, and quality of life. Currently, home high-flow nasal cannula is being studied for frequently exacerbating COPD, with early evidence of fewer flare-ups. Precision medicine is transforming airway care. In 2024, dupilumab became the first FDA-approved biologic for COPD with eosinophilic inflammation, reducing exacerbations and improving lung function. Asthma management has long incorporated biologics such as anti-IgE, anti-IL-5, and anti-IL-4R therapies, with newer agents like tezepelumab broadening eligibility. However, there are still barriers to biologics, including face cost and prior-authorization hurdles. Other digital tools, including tele-rehab and connected inhalers, promise to extend reach but depend on patient access and adherence. For primary care, timely referral is critical. Pulmonary rehab within 90 days of hospitalization lowers mortality, and routine checks of eosinophils or FeNO can guide escalation toward biologics. Within the next five years, we may see wider adoption of biologics for COPD, increases in device therapies like lung denervation, and integration of digital ecosystems that monitor patients remotely to deliver earlier interventions. Shifting toward treatable traits could further personalize therapy and improve outcomes across both COPD and asthma patients.

Innovations beyond inhalers are coalescing around pulmonary rehab, precision monitoring, and targeted interventions. Career readiness & job training: We deploy pulmonary rehabilitation "anywhere"—center-based, home-based, and tele-rehab—with supervised exercise, breathing retraining (pursed-lip, diaphragmatic), inspiratory muscle training, and self-management coaching to reduce exacerbations and boost functional capacity. Educational & digital tools: Remote spirometry, wearable oximetry, and app-based symptom diaries feed risk dashboards that flag early deterioration. Connected devices that coach inhaler technique and nudge adherence meaningfully improve day-to-day control. Personalized oxygen: We titrate targets (often SpO2 88-92% in at-risk COPD) rather than defaulting to blanket high-flow, and re-assess needs ambulatory (6-minute walk) and overnight. Compared with standard oxygen, individualized protocols reduce hypercapnia risk and better match exertional demand, improving comfort and mobility. Biologics/precision medicine: In severe asthma, biologics (anti-IL-5, anti-IL-4/13, anti-TSLP) are standard for Type-2-high phenotypes; in COPD, targeted biologics are emerging for eosinophilic subgroups. We phenotype with blood eosinophils, FeNO, IgE, comorbid atopy, and exacerbation patterns to guide escalation. Barriers: Cost and prior authorization, limited pulmonary rehab capacity, digital literacy gaps, transportation, and inconsistent access to spirometry remain the biggest obstacles. Primary care integration: Ensure confirmatory spirometry, teach/assess inhaler technique at every visit, refer to pulmonary rehab (especially within 4 weeks post-exacerbation), optimize vaccinations and smoking cessation, and set clear referral triggers for biologics and complex oxygen cases. Next 5 years: Tele-rehab at scale, AI-augmented early-warning systems, simpler blood-based phenotyping for COPD, expanded biologic indications for defined endotypes, and more seamless home NIV/oxygen integration.