Podcasts about copd

In medical school, Aaron Baugh, like most doctors in training, was taught that Black people have smaller lungs than white people. His professors explained that it came down to evolution and body proportions.A spirometer measures lung capacity and helps doctors diagnose and treat most lung diseases, including asthma, COPD, and cystic fibrosis. And for generations, it had a so-called race equation built into it. When a patient breathes into the machine, their lung capacity is compared to what is considered normal for their age, gender, and race. For Black patients, that normal range was 10 to 15 percent lower than for white patients. For years, doctors believed that a race “correction” made the test more accurate.But after becoming a pulmonary and critical care physician, Baugh discovered that historical assumptions embedded in the spirometer were not only wrong, but were based on racist science that can be traced back to American slavery. And they were leading to misdiagnoses in thousands of Black patients, including military veterans. “This is not a small test,” Baugh says. “It is used in diagnosis of lung disease. It is used for job hiring. It is used for disability assignments. It is used for different medical treatments. So it can touch people in a lot of important ways if you're doing this wrong.”This week on Reveal, we team up with The Race Equation podcast series from the New England Journal of Medicine to examine a standard medical test with a brutal history that is harming Black patients and is still being used in hospitals across the country. Support Reveal's journalism at Revealnews.org/donatenow Subscribe to our weekly newsletter to get the scoop on new episodes at Revealnews.org/weekly Connect with us on Bluesky, Facebook and Instagram Learn about your ad choices: dovetail.prx.org/ad-choices

HEALTH NEWS   Move over, lycopene. Tomatoes' secret sauce may be phytoene A Hidden Gut Reaction May Explain Why Vegetables Are So Good for You Artificial sweetener xylitol associated with higher risk of adverse cardiovascular events Can you slow the aging process? Study reveals which interventions might help Overuse of inhalers found to increase heart attack risk in asthma and COPD patients

What if your pharmacist could help optimize a patient's asthma treatment before their next clinic visit? On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash welcomes clinical pharmacist Dr. Joelle Ayoub to discuss how ambulatory care pharmacists can partner with ENT and allergy clinics to optimize asthma management. Dr. Ayoub shares her experience working in a family medicine clinic, collaborating with providers through referrals, reviewing medications, and providing direct patient education on inhaler use and disease management. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:40 - The Role of the Clinic Pharmacist05:04 - Teaching Patients and Improving Inhaler Technique12:36 - Choosing Inhalers and Applying Guidelines18:51 - Comparing MDI, DPI, and SMI Devices28:15 - Tracking Asthma Control and Monitoring Adherence33:55 - Inhaler Education and Overcoming Barriers40:00 - Using Social Media for Patient and Provider Education44:16 - Pharmacist Collaboration and the Future of Team Care50:58 - Answering Biologics Patient Questions53:15 - SMART Therapy and Digital Inhaler Advances55:19 - Wrap Up --- More about this episode They discuss common gaps in asthma care, with a focus on inhaler technique and medication adherence. Dr. Ayoub explains how device complexity, cost, and a patient's ability to use their inhaler can all affect treatment. She also reviews the major inhaler types, common technique errors, and what to consider when choosing the right device for each patient. With this, Dr. Ayoub shares practical approaches to adherence monitoring, asthma guideline updates, and biologic monitoring. Throughout, Dr. Ayoub emphasizes the benefits of multidisciplinary collaboration and how pharmacists can help bridge gaps in care for patients with asthma. --- Resources Joelle Ayoub, PharmD, BCACP, APh - https://www.westernu.edu/bios/?bio=jayoub --- BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Project Anchor turned out to be yet another failed, click-bait conspiracy prediction. The world did not lose gravity on the 12th of August for enough time for people and things to levitate. However, there was a solar eclipse that occurred on that day. But won't stop the next round of Internet rumors, lies, and scams. The Internet is awash in time traveler stories, futuristic predictions, and conspiracies that are so insane they discredit legitimate conspiracies.  Sure, people have been killed for knowing too much about something they shouldn't, but every death is not a conspiracy. Take Max Spiers, who overdosed on a generic version of Xanax while engaged to a legitimately insane, and seriously overweight, woman named Sarah Adams who claims to be a healer and psychic. Or take David Wilcock, a man suffering from self-made financial issues, self-delusions about his life, and a lifetime of depression that led to him taking his own life. But his fans couldn't let him rest; in a bout of hysteria similar to Wilcock's own delusion, his supporters created every possible scenario to justify an argument that he was still alive and working on secret technology. HIs family and friends begged them to stop. The same thing even happened after legendary radio personality Art Bell died of COPD, and Jim Marrs of kidney issues.  Recently, it's the death of Joe Felz, a van life influencer who made videos of rare books, is the center of attention. Joe was reportedly killed by dark forces that wanted to suppress his book, some of which are free online to read. HIs girlfriend, however, says to leave him and his family alone as they grieve. If dark forces wanted to suppress information though, they would control it on the Internet, perhaps buying up rare books, scanning them, and destroying the original. This is precisely what AI companies are being accused of at the moment. Perhaps the story of Felz is cover for the latter? Or maybe, as is supposed, he was suicidal. *The is the FREE archive, which includes advertisements. If you want an ad-free experience, subscribe below. 

As Diane Meier remarks to start today's podcast, palliative care has come a long way from the days when we were the "brink of death" consult. We're seeing patients earlier and earlier in the course of illness.  In fact, the evidence base for specialist palliative care is arguably stronger in the outpatient setting than the inpatient setting. In some ways, as Eric remarked, we are a victim of our own success. We've pushed on the boundaries of seeing patients earlier in the course of illness, we've demonstrated remarkable value to our colleagues and health systems: now they want us to see more and more patients, with conditions we would not have previously considered core to palliative care practice. Our guests modeled respectful disagreement, and we were somewhat surprised that there was more agreement than we expected.  I'm sure you will all have strong feelings about the opinions expressed, please let us know! In addition to Diane Meier, we welcome back Bob Arnold and Justin Sanders to talk through these issues, including: We agree specialist palliative care is for people with "serious illness" - but what constitutes "serious illness" Is a limited prognosis part of the definition of serious illness?  We discuss the Center to Advance Palliative Care definition of palliative care and Amy Kelley's oft-cited definition of serious illness.   Many patients with conditions that overlap with palliative care would benefit from our help, e.g. chronic pain, opioid use disorder, mental illness. Our health system is not meeting their needs.  Should palliative care see them, in the absence of a clear life-limiting illness? How limited a prognosis should we consider here - months, years…decades? We have a tremendous workforce shortage.  There are not enough specialist palliative care providers to see all patients with advanced cancer, much less the many other conditions whose guidelines now say should include palliative care.  The reality does not match the mission.  Does that change our mission?  Should local workforce issues dictate who should see palliative care? See this article by Pelleg in which clinicians at Mt Sinai agreed that patients with serious illness and high risk of mortality should be prioritized, explicitly excluding patients with chronic pain or psychosocial distress in the absence of serious illness. What is the role for Patient Reported Outcomes (PROs)? e.g. patients regularly reporting pain or other symptoms and an escalation in symptoms triggering a palliative care intervention.  How is the definition of who should see palliative care expanding in Canada, and is there a linkage to who is eligible for medical aid in dying in Canada.  Justin makes a good plug for the McGill National Palliative Care Grand Rounds Programme What is our vision for where palliative care should be 10 years from now? Population health specialists, or healing patients one visit at a time? To be sure, these are not mutually exclusive. How long should palliative care fellowship be - should we expand it to 3 years so palliative care specialists can care for people with a wider range of conditions?   What is Precision Palliative Care? Diane mentions this article by Ramy Sedhom on a couple of occasions.   Should palliative care see patients with sickle cell disease? How about survivorship clinics? How about very elderly patients with multiple mild chronic conditions (e.g. mild heart failure, mild COPD, mild cognitive impairment, arthritis, diabetes, hypertension)? And much more! Please listen to the audio only version of Stand by Me - my son Renn added an upright base, snap, and triangle parts - it's much better than the live version for YouTube that I accidentally started in a much too high key!  

Disclaimer: This episode and article are for educational purposes only and are not a substitute for individualized medical advice. Always consult your physician before making changes to your diet, exercise routine, or medications.TL;DR* The CDC's top 10 causes of death account for roughly 74% of all deaths in the US each year, and up to 80% of chronic disease is estimated to be driven by lifestyle factors — diet, movement, sleep, stress, and toxin exposure. * This episode goes cause by cause (heart disease, cancer, COVID/respiratory disease, accidents, stroke, Alzheimer's, diabetes, kidney disease, flu/pneumonia, and suicide) and lays out what the peer-reviewed research says about preventing, slowing, or reversing each one.* Ready to build your own plan? Book a free Metabolic Blueprint Session →The List, and the Number That Should Keep You Up at NightAccording to the CDC, ten conditions account for about 74% of all deaths in the United States every year:* Heart disease* Cancer* COVID-19 / chronic lower respiratory diseases* Accidents (unintentional injuries)* Stroke* Alzheimer's disease* Diabetes* Kidney disease* Influenza and pneumonia* SuicideHere's the part that doesn't get said enough: research estimates that up to 80% of chronic disease is driven by lifestyle factors — diet, movement, sleep, stress, and toxin exposure. Those aren't destinies. They're decisions, and decisions can change.A landmark paper in the Journal of the American Medical Association found that poor diet alone accounts for more deaths in the US than tobacco use. The fork may be more dangerous than the cigarette. And yet, most patients who end up on four to six medications were never once asked what they eat, how they sleep, or whether they move their bodies before those prescriptions were written. That's the difference between a sick care system and a healthcare system.Heart Disease and Stroke: The Most Reversible Disease We KnowHeart disease kills one American every 34 seconds and has held the #1 spot for over a century. But it's also one of the most reversible conditions in medicine.In 1990, Dr. Dean Ornish's landmark Lifestyle Heart Trial showed that intensive lifestyle changes — diet, exercise, stress management, and social support — could reverse coronary artery disease without drugs or surgery. Arterial plaques reduced. Blood flow improved. Chest pain decreased. A 2019 study in the Journal of the American College of Cardiology confirmed it: a plant-predominant diet, regular aerobic exercise, not smoking, and a healthy weight reduced cardiovascular risk by over 80%.What that looks like in practice:* A Mediterranean or whole-food, plant-based diet rich in omega-3s and antioxidants (this isn't the only diet that works — it's the broadest evidence-backed baseline)* Zone 2 cardio (low-intensity aerobic work, three to five times a week — a brisk walk counts)* Managing chronic inflammation, the real driver of arterial plaque formation* Reducing refined sugar and seed oils, which damage the endothelial lining of the arteries* Prioritizing sleep, since poor sleep spikes cortisol and directly harms the heartStroke follows the same playbook: control blood pressure through diet, exercise, and stress reduction. The DASH diet in particular has been shown in multiple studies to lower blood pressure as effectively as medication in many patients.Cancer: 30–50% Preventable, and Possibly More Metabolic Than GeneticTo be clear, this isn't a claim about curing cancer — it's about how much prevention research is available and underused. The World Health Organization estimates that 30–50% of cancers are preventable. The American Institute for Cancer Research has identified lifestyle factors that dramatically reduce risk across multiple cancer types:* Diet. A 2022 meta-analysis in The Lancet linked poor dietary patterns — low fiber, low fruit/vegetable intake, high processed meat — to one in five cancer deaths globally.* Obesity. Excess weight is now the second-leading risk factor for cancer after smoking, because fat tissue is metabolically active and produces hormones like estrogen and inflammatory cytokines that fuel cancer growth.* Exercise. A 2019 study of over 1.4 million people found higher physical activity was associated with lower risk across 13 cancer types, including breast, colon, and endometrial cancer.* Fasting and metabolic health. Emerging research on intermittent fasting and time-restricted eating shows it can lower insulin-like growth factor, a key promoter of cancer cell proliferation.* Toxin reduction. Chronic low-grade exposure to pesticides, plastics (BPA, phthalates), and environmental pollutants has been linked to increased cancer risk. Choosing organic where possible, filtering water and air, and reducing plastic in cookware and storage all matter.There's also a deeper shift happening in how researchers understand cancer itself. It's long been treated primarily as a genetic disease, but the evidence is increasingly pointing toward cancer as a metabolic disease. Dr. Thomas Seyfried at Boston College has done groundbreaking work showing that cancer cells overwhelmingly rely on glucose and glutamine fermentation for energy — which is why a ketogenic or low-glycemic approach may help starve cancer cells while protecting healthy ones. The research is still evolving, but it's compelling.Think of your body like a garden. You can water it, enrich the soil, and pull the weeds — or you can dump sugar and chemicals on it and wonder why nothing grows right. Disease doesn't happen to you. It grows in an environment you create, consciously or not. The good news: you can change that environment starting today.Alzheimer's: “Type 3 Diabetes”Alzheimer's is rising, and it's terrifying to watch someone go through it. But emerging science shows it has a strong lifestyle and metabolic component — researchers now sometimes call it “type 3 diabetes” because of the profound link between insulin resistance and neurodegeneration.Dr. Dale Bredesen's ReCODE Protocol, published in the Journal of Aging, showed that a multimodal lifestyle intervention — diet, exercise, sleep optimization, hormone balancing, and stress reduction — reversed early cognitive decline in the majority of patients treated. In his 2014 case series, 9 of 10 patients with early Alzheimer's or mild cognitive impairment showed measurable improvement, with several returning to work.Key strategies from the research:* Sleep is non-negotiable. The brain's glymphatic (waste clearance) system activates primarily during sleep, flushing out amyloid beta plaque. Poor sleep means plaque buildup.* Exercise. A 2020 study showed aerobic exercise increases BDNF (brain-derived neurotrophic factor) — essentially fertilizer for neurons — and reduces dementia risk by up to 35%.* Mediterranean-MIND diet. Shown to slow cognitive aging by an estimated 7.5 years in adherent individuals.* Blood sugar management. Insulin resistance in the brain disrupts its ability to use glucose for energy, effectively starving neurons.* Social connection. Harvard's 80-year longitudinal study found relationship quality was the single strongest predictor of cognitive health and longevity in old age.Type 2 Diabetes and Kidney Disease: One Disease Driving AnotherOver 37 million Americans have type 2 diabetes, and another 96 million are pre-diabetic. Here's the part that surprises people: type 2 diabetes is reversible in the majority of cases, and this isn't controversial — the science is overwhelming.The 2019 DiRECT trial, published in The Lancet, found that nearly half of type 2 diabetics achieved full remission through an intensive dietary intervention alone, with no medication. Other studies using low-carbohydrate and very-low-calorie diets have replicated these results consistently.Diabetic nephropathy — kidney damage from chronically high blood sugar — is the leading cause of kidney failure in the US. Control the upstream issue (blood sugar and metabolic dysfunction) and you protect the downstream organ.The diabetes reversal framework from the research:* Dramatically reduce refined carbohydrates and added sugars to blunt insulin spikes and reduce fat storage in the liver and pancreas* Practice time-restricted eating or intermittent fasting to improve insulin sensitivity* Add resistance training — muscle is your biggest glucose sink, so more muscle means better blood sugar control* Reduce visceral fat (the fat around and inside your organs), a key driver of insulin resistance and inflammationIf this list feels like a lot, that's fair. But it's not about blame — it's about empowerment. You have more control over your health outcomes than the medical system has typically told you.Respiratory Disease, Flu, and PneumoniaChronic lower respiratory diseases like COPD and emphysema are largely driven by smoking and air quality. Quitting smoking remains the single most impactful intervention here, full stop.For flu and pneumonia risk, immune resilience matters: vitamin D optimization, zinc and elderberry, and gut microbiome health (roughly 70% of your immune system lives in your gut). Even mild sleep deprivation has been shown to quadruple susceptibility to viral infection.Suicide and Mental HealthThis is the cause of death nobody wants to talk about, but it's in the top 10 — and it's the leading cause of death for men under 50, and the second-leading cause of death for people ages 10–34.While this is complex and deeply personal, research points to several lifestyle levers:* Exercise functions as an effective antidepressant, largely through endorphin release* The gut-brain axis matters more than most people realize — over 75% of the body's serotonin is produced in the gut, so gut health directly shapes brain chemistry* Social connection and purpose. Viktor Frankl's Man's Search for Meaning, written while he was in a Nazi concentration camp, captured this: meaning and connection to purpose are essential for survival, and perspective shapes both physiology and outcome* Reducing alcohol, a central nervous system depressant that worsens anxiety and depression despite short-term reliefIf you or someone you love is struggling, crisis hotlines are available 24/7. There's often a reason it's happening, and there's often a way through it.The Common ThreadAcross every single one of these conditions — heart disease, stroke, cancer, Alzheimer's, diabetes, kidney disease, respiratory disease, immune function, mental health — the same five levers keep showing up: diet, exercise, sleep, toxin reduction, and blood sugar balance.Your daily habits are either building disease or building resilience. Every meal, every walk, every night of good sleep compounds — just like interest in a bank account.This Week's Action Plan* Do a food audit. For the next three days, write down everything you eat. No judgment, just awareness — you can't change what you can't see.* Walk 30 minutes a day. It lowers blood pressure, improves insulin sensitivity, boosts BDNF, and reduces cortisol. Simple, not easy — do it anyway.* Optimize your sleep. Consistent bedtime, dark room, cool temperature, no screens.* Get your labs done. Know your fasting glucose, A1C, CRP, vitamin D, triglycerides, and LDL — these are your early warning systems.* Address one stress source this week. A conversation you need to have, a boundary you need to set, or ten minutes of breathwork. Chronic stress is silently killing you — take action on it.Ready for a Real Plan?If you're ready to take your health seriously and want a clear roadmap instead of guesswork, book a Metabolic Blueprint Session. In 30–45 minutes, we'll walk through your top three priority areas and how programs like the Metabolic Momentum Accelerator, the Cellular Reboot Accelerator, and the Total Health Restore Protocols can help.Schedule your complimentary consult →Know someone this could help? Share this episode with them — it might change or even save their life.If this episode was valuable, leaving a review on Spotify or Apple Podcasts helps this show reach more people.ReferencesStudies and sources cited in this episode:* CDC — Leading Causes of Death data* Journal of the American Medical Association (JAMA) — poor diet and US mortality* Ornish, D. et al. (1990) — The Lifestyle Heart Trial* Journal of the American College of Cardiology (2019) — plant-predominant diet, exercise, and cardiovascular risk reduction* DASH diet research on blood pressure control* World Health Organization (WHO) — cancer preventability estimates* American Institute for Cancer Research — lifestyle and cancer risk* The Lancet (2022 meta-analysis) — dietary patterns and cancer deaths* Physical activity and cancer risk study (2019, ~1.4 million participants)* Seyfried, T., Boston College — cancer as a metabolic disease* Bredesen, D., Journal of Aging — the ReCODE Protocol; 2014 case series* BDNF and exercise study (2020) — dementia risk reduction* Mediterranean-MIND diet and cognitive aging research* Harvard Study of Adult Development (80-year longitudinal study) — relationships and longevity* DiRECT Trial, The Lancet (2019) — type 2 diabetes remission through dietary intervention* Frankl, V. — Man's Search for MeaningThis article summarizes claims and studies as presented in the podcast episode. Listeners are encouraged to review primary sources directly and consult their own physician before making health decisions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit tripleplaydoc.substack.com/subscribe

Manfred Wader über Scheitern, Neuanfang, COPD – und seine Leidenschaft fürs Singen.

Manfred Wader über Scheitern, Neuanfang, COPD – und seine Leidenschaft fürs Singen.

Experts discuss updated strategies for minimizing steroid exposure in COPD. Credit available for this activity expires: 8/5/27 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/when-steroids-signal-risk-rethinking-copd-exacerbation-2026a1000q7m?ecd=bdc_podcast_libsyn_mscpedu

This program is non-promotional and is sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. The content contained in this program was jointly developed by AMJ, the speakers, and Sanofi and Regeneron, and is not eligible for continuing medical education (CME) credits. The speakers were compensated by Sanofi and Regeneron in connection with this program.   COPD trial outcomes are not all equal, yet conventional endpoints can make it difficult to weigh severe events, exacerbations, lung function, and symptom burden within a single clinical picture.   In this AMJ podcast, Sanjay Ramakrishnan and Simon Couillard discuss how win ratio methodology may help capture a broader, more clinically meaningful view of treatment benefit by comparing outcomes across a prespecified hierarchy.   Listen to the full episode to learn:   Why standard COPD endpoints may not tell the full story How win ratio analysis prioritizes outcomes by clinical importance What the pooled BOREAS and NOTUS analysis showed How this approach could shape future respiratory trial design Speakers: Sanjay Ramakrishnan, Clinical Senior Lecturer, UWA Medical School, Centre for Respiratory Health, The University of Western Australia, Perth, Australia Simon Couillard, Professor, Faculty of Medicine and Health, Université de Sherbrooke, Quebec, Canada

Walking Football: Fußball ohne Sprint, aber mit großer Wirkung: Gehen statt laufen, passen statt hetzen: Walking Football bringt Menschen zurück auf den Platz, die sich klassischen Fußball nicht mehr zutrauen. Das Angebot richtet sich vor allem an Menschen über 50 sowie an Personen mit gesundheitlichen Einschränkungen. Entscheidend ist nicht das frühere Leistungsniveau, sondern die Freude am Ball. Im Podcast erzählt der Journalist und Autor Uwe Mauch, wie Walking Football seine körperliche und mentale Verfassung verändert hat. Auch Anfänger finden Zugang zum Spiel. Einer seiner Mitspieler begann mit 67 Jahren – ohne je zuvor Fußball gespielt zu haben. Andere berichten von sichereren Schritten, besserem Gleichgewicht und mehr Beweglichkeit im Alltag. Wunder verspricht Mauch nicht. Wer Gelenk- oder Lungenprobleme hat, muss die eigenen Grenzen kennen und sollte Beschwerden medizinisch abklären. Mindestens ebenso wichtig wie das Training ist die „dritte Halbzeit“. Beim gemeinsamen Essen, Trinken und Reisen entstehen Kontakte und Freundschaften. So wird Walking Football zum Gesundheitssport gegen Bewegungsmangel und soziale Isolation. Der schwierigste Schritt bleibt der erste: zum Training zu kommen. Danach, sagt Mauch, bleiben viele dabei

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Karin G. Johnson, MD, FAAN, who served as the guest editor of the August 2026 Sleep Neurology issue. They provide a preview of the issue, which publishes on August 3, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Johnson is a Professor in the Department of Neurology at the University of Massachusetts Chan School of Medicine–Baystate and the Sleep Medicine Division Chief at Baystate Medical Center in Springfield, Massachusetts Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @drsleepykarin  Full episode transcript available here Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Albin: All right, welcome all. For the first time ever in the history of Continuum Audio, we are coming to you live from Chicago here at the AAN annual meeting. And now over to your host, the one and only editor-in-chief, Dr. Lyell Jones.  Dr Jones: Welcome, everybody. My name is Lyell Jones, editor-in-chief of Continuum, and I'm here today with Dr. Karin Johnson, and we're interviewing Dr. Johnson for the upcoming and recently published issue of Continuum on Sleep Neurology. We have been doing Continuum Audio for a while, but we're doing something different this time. As our listeners online can tell, we are recording this for the first time ever with a live studio audience at the American Academy of Neurology annual meeting in Chicago, Illinois. So, this is a fun experience for us. I hope it's been fun so far for you, Dr. Johnson.  Dr Johnson: Great to be here.  Dr Jones: It's great to have you. So, before we get into the interview, I do wanna introduce our team here for the live recording of the podcast. You've already heard Dr. Casey Albin's voice. Dr. Casey Albin is an associate professor of neurology at Emory University. Also serves as one of our associate editors at the journal and one of our Continuum Audio interviewers. So, she's going to be working the crowd today. Let's have a round of applause for Dr. Albin. And our guest of honor today is Dr. Karin Johnson. Dr. Johnson is a professor of neurology at UMass Chan Medical School and, Baystate Medical Center in Massachusetts. She is a world-renowned expert in sleep neurology and is the guest editor for the most recent issue of Continuum on Sleep Neurology. Dr. Johnson, welcome. Why don't you introduce yourself to our audience?  Dr Johnson: You did a great introduction, but I'm a clinical sleep medicine specialist. Spend my days seeing patients, taking care of people with narcolepsy, sleep apnea, restless legs, everything that comes my way. And then I have a side interest in doing sleep medicine advocacy, especially for permanent standard time.  Dr Jones: And we may get to that. I mean, that might be part of our conversation today. So, you've now read all of the articles in this issue, and it's a really great issue. There's a lot of new developments in sleep neurology. There are some updates for clinicians, people who see patients with sleep disorders that I think are, are timely and important updates. You have this unique view because you have just read all of these articles, really good articles by expert authors. When you read through these, Dr. Johnson, what was the biggest, what was the biggest thing that surprised you?  Dr Johnson: I think the biggest surprise for me is just so many changes in, in all of these articles. I realized how easy it was for us to make a journal that is so different from a few years ago. Whether it's Dr. Stahl's obstructive sleep apnea and new ways to think about endotyping sleep apnea that is gonna have treatment implications or the new treatments that are out there like tirzepatide, the changes that we're having with restless leg treatment. I particularly wanted to have a chapter on circadian neurology that Dr. Abbott did a great job really highlighting how if we think about the timing of when we give meds, the timing of when we eat, how that really can help neurological health, brain health, overall health, as well as mental health and cognition, especially as the AAN thinks about brain health as a whole, not just treating our patients, but how we can treat the population of people by improving sleep. I like how we hit on all these different areas in this issue.  Dr Jones: And I don't know how you managed to do it. They're just a small number of articles. We cover a lot of existing territory with well-characterized diseases, with new advances. But there's a lot of new stuff in sleep, and so somehow, it's all packed in there. It's really impressive. One of the things I was gonna ask you about was an evolution, and this has been a number of years now in how we manage restless leg syndrome. When I was training, it was all about dopamine agonists, and that was your first line. And over time, the evidence has supported moving away from that, and now we have more recent guidelines that have come out, and it's really the alpha-two delta-one calcium channel antagonists. How is that transition going? Do you still see people in practice who come in on dopamine agonists? How is that going? How's the field responding to that?  Dr Johnson: That's one of my most frequent restless leg consults. So even though it's been years since I have really initiated dopamine agonists in my patient, every day we get in people often on very high doses of dopamine agonists, and their doctors have just been escalating and escalating these meds over the years, and they come in with horrible augmentation. Their symptoms are much worse than they used to be, happening earlier in the day. And so, trying to get these patients off of these meds that are addictive, the way I like to teach about it is these dopamine agonists are the Fioricets of the sleep world. We know they work great, but in the long run, the patients are gonna be worse overall. And so, it's so hard to get people off these dopamine agonists, just like it's so hard to convince a headache patient that they don't need their Fioricet and that they're gonna be better off if we can get them off of it. What I think has really changed is we have more options to use. So, the alpha-delta-like agonists like gabapentin are now considered first line, but there's a lot of patients who they just don't work well enough with or they don't tolerate. And so, what do you do in that case? It's easy when that works, but and, when that doesn't work, we are being much more aggressive these days with iron replacement, potentially even trying to push ferritin levels in refractory patients up to three hundred, and using IV iron rather than just oral iron to get over the absorption issues to get the brain levels high enough. Motor stimulators, little cuffs that kind of go around the leg and stimulate the peroneal nerve in a certain way that not only can give people immediate relief, but also some data that suggests that over time it actually lessens their restless legs. We have agents like dipyridamole that work on the adenosine system in a sort of new novel pathway at addressing restless legs. And then the opiates, often meds like methadone or Suboxone can be used in some patients. But as we're getting more of these other options, often we don't need to go to those levels because we do have more to work with.  Dr Jones: So, the key point is lots of options. We're not starting with dopamine agonists anymore. And I think the fact that you're still seeing a lot of patients who have been initiated on that probably tells us there's an education gap field that we need to work on. So, another thing that I noticed reading through the issue was, and this feels like a change over the last few years, is the availability and the tendency to use in-home sleep apnea testing as opposed to formal, traditional in-lab. And that feels like a great new option, and maybe that increases and improves availability for patients who need access to the test. But how do you work through that?  Dr Johnson: So, I love in-home testing. We've been using it for over a decade. Other parts of the country where insurances didn't sort of mandate it are now being more mandated. I think the real change happened for a lot of places over the pandemic when labs closed down. But I think it's good because it brings a lot more patients to us. They get tested, they get tested quicker. People who would say, "I would never go into a lab. Oh, I'll do a home study." So, it just does bring more people in, and it gets them to treatment that they need that can really be life-changing. But it's not for everybody. The biggest people are people that have other bad pulmonary issues. If you're on oxygen therapy, you should not be getting a home study. That really should be a group of people that come in the lab. Similarly, if you have bad COPD, you probably should be getting a full in-lab study, so we can get more monitoring. Central sleep apnea is an interesting one. It can be very hard in some cases to differentiate the centrals and obstructive nature as well on a home study. Doesn't mean you can't do a home. So, if it's a person that just can't get an in-lab study easily, maybe you start with the home. If it looks purely obstructive, and you're all set, then you got an answer, and you can move on. But if you get back a home study that looks questionably central, they're gonna need to come into that lab. So, if you already know they're high risk because they're on narcotics, cause they have congestive heart failure, it's usually worth going straight to the lab. But again, you may consider a home study based on the patient. Patients that really cannot use the equipment can also be an issue. So, if they've had a debilitating stroke and have no one to help them put on that device, or cognitively they just can't handle the device, they're gonna be someone who's gonna benefit from coming into the lab and getting the help from the techs. So, those are the big populations that you might go starting for a home. And then the other thing that confuses a lot of people, the home is only for diagnostics. It really isn't for treatment. So, I have patients that say, "Oh, like, you can just titrate my CPAP with a home study." No. So if it's a treatment decision where they're not doing well on treatment, or I need to figure out do they need CPAP or BiPAP or IVAPS or one of these more complicated treatments, those are people that are gonna need to come into the lab to get that treatment portion of the evaluation.  Dr Jones: What a great summary. That's like everything I needed to know about who do I need to bring into the lab and who do I think maybe could do an at-home study. Really great. And speaking of devices, I think all of us who see patients in the room here and our listeners out there online have experienced patients, and this feels like a very recent phenomenon to me, are coming in with their commercial at-home wearable device. And they have printouts sometimes, and they show me their phone, and they give me some numbers that I don't really know how to interpret. Reading through this issue, I learned a couple of great new words. I learned about orthosomnia, right? So, people who become so preoccupied with their sleep, it keeps them awake at night, literally, right? I mean, it's a complete paradox. I learned about nearables, so things that aren't necessarily wearables that are just in the room while the patient is sleeping that monitor proxies for sleep quality, sleep stage, and other things. And I frankly, I'm not really sure what to tell patients. So, what do you tell patients who come in with all the data? Like, or how do you tell patients to use these?  Dr Johnson: I think these devices can go both ways. So, I do kind of say the pros and cons of these devices. I think for a lot of patients, they're empowering. It's getting them to think about sleep, to wanna know how good their sleep is. Are they getting enough sleep? So, if it's used in those ways, it's gonna be very helpful. I actually had a patient last week, and they noted that they're having big desats all night and could show me essentially an overnight oximetry data rather than me having to order it, and I had days of data, which sometimes can be too much. But in this case, it's like, oh, when he was on his side that night, he looked a lot better, so I can use that to give advice to the patient about particular treatments. He actually went down to Mexico, and a doctor friend gave him oxygen therapy while he was there randomly. And we could see on the nights that he had the oxygen therapy, it did really help his central sleep apnea pattern. And so that pushed us towards saying, "Let's qualify you for that up here in the States." So, I think in some cases it can give really important data. Now, I saw a posting on social media the other day of someone saying, "Can I get advice on how to improve my REM sleep? My tracker says I have no REM sleep, and I need to do something about it." There's really not data to support needing to do something about it. And so, I do think it can get some people on these wild goose chases, trying to get to a certain percentage of sleep. And these trackers, they're good in a lot of ways, but they're not perfect. He could be getting REM sleep that the tracker on him does not show. You want to relate it to what symptoms are they having. I think they can be very good for trying something out. So, let's say someone, has their tracker telling them they get five hours of sleep, and they try this intervention, and that helps them show that they got the seven hours of sleep, or they went from no REM to REM and it goes in the right direction. It can help give them that positive feedback that something they're trying, is working. But the absolutes for any given patient, it's hard to over-- What does it mean if it says you've got a 50% score versus a 70% score? That may or may not be meaningful in any given person, but again, they can compare themselves to themselves. If they were a lower score and now they're a higher sleep score because they did something that was meaningful, and that goes along with them feeling better, that can help give them that positive feedback to do something good.  Dr Jones: So, a little bit of a mixed picture.  Dr Johnson: Yeah.  Dr Jones: Sometimes they help. Sometimes they distract. Hopefully- Dr Johnson: And as a provider, sometimes it can be overwhelming because they're like, "Come look at my year's worth of data." And you're like, "No."  Dr Jones: Yeah.  Dr Johnson: You know, let me see one page or two pages of data and be like, "Yep, okay, I get it." Dr Jones: Just show of hands in the audience, who in the room wears a sleep device at night, like a ring or a, some kind of sleep monitoring app? That's about half the audience.  Dr Johnson: This is why they're here.  Dr Jones: So that's really helpful, and I think it is. You want to be supported by the data. You want to be supported by evidence and high-quality biometric evidence. Another big trend, and this has been a number of years in the making, is the understanding, Dr. Johnson, of the relationship between sleep physiology and neurodegenerative disease. One of the things I love about neurology is there's still so much left to learn about the normal physiologic functioning of the brain. So glymphatics and other aspects of sleep physiology that we didn't know about a decade or two ago. When you think about how that relationship has developed, sleep physiology, maybe sleep disorders and neurodegenerative disease, how has that changed your approach to talking to patients? Do you counsel patients differently now because of what we understand better about that?  Dr Johnson: Yeah, I mean, we are still limited with our data. We have so many studies that show the associations between whether it's not enough sleep, too much sleep, or having a sleep disorder like obstructive sleep apnea, and that being a risk factor for stroke or Alzheimer's or Parkinson's. But we still sort of lack the treatment trials that necessarily say, "If you treat obstructive sleep apnea, you're gonna have less dementia," or, "You're gonna be less likely to have that stroke." So, we have a lot of physiological studies, a lot of reasons why it makes sense, but we don't have that final, nail in the coffin to say, "If you do this, you'll definitely be better." So, we know certain groups are more at risk. If you have obstructive sleep apnea and you are symptomatic, you seem to have higher cardiovascular risk. If you have a person who's had a stroke and we find a milder case of sleep apnea, and they're someone that's totally asymptomatic. They say, "I sleep fine. I feel fine." There's not great data to say, "If you treat your sleep apnea, you're gonna be less likely to have a stroke." Now, if they come in and they're sleepy and their sleep apnea is really severe, and they have more hypoxic burden, which is also more connected with a lot of these risks, I'm going to say, "I think you are in the higher risk group of sleep apnea people who it's probably gonna be more likely to help your cardiovascular risk, your dementia risk." We can counsel them, and then it's really a personal decision. Some people are like, "No way. I'm never gonna use a CPAP machine, ever." And other people are like, "You know, my mom had a stroke. My dad had Alzheimer's. I want to do every possible thing I can to make it less likely that I have this outcome that I want to avoid." And so, you're going to take that in to, you know, do you want to try this treatment or not? It's a lot easier when you have outcomes that you can follow, like, "If I try CPAP, does my blood pressure get better? Do I stop having AFib attacks?" It's a lot harder when, will I or not get Alzheimer's ten years down the road or have that stroke?  Dr Jones: It's hard to get people to do things for kind of an abstract prevention down the road, but could be important. Are there trials going on that are going to assess this data?  Dr Johnson: Yeah. We currently have a big trial getting people right away, right after their stroke, on CPAP, and not only looking at prevention, but also looking at recovery outcome. It's been running for several years. Hopefully, we'll get enough data to close out the study coming up.  Dr Jones: We'll look forward to that.  Dr Johnson: Yeah.  Dr Jones: So, I'm really excited to get to our audience here, but before we do that, I do want to ask Dr. Johnson one more question. Dr. Johnson is famous for her advocacy for sleep in general, but specifically related to Standard Time. So, let's do a little experiment here. I didn't warn Dr. Johnson about this, so we'll see how she does. She does a ton of advocacy. She's a pro. So, pretend like we're in DC, and I'm a senator, and we just got in an elevator. You're going to give me your elevator pitch on what we should do.  Dr Johnson: So, you know, sleep is one of the few essential things in life. We need to eat, we need to drink, we need to have clean air, and we need to sleep and when we improve sleep, we can improve basically every outcome, whether it's academics, whether it's productivity, whether it's our physical health, our mental health. And the problem is we structure our lives in a way that really keep people, and especially our teenagers, from getting the sleep they need. And one of these structural things we do is permanent daylight savings time. Essentially, what you're doing is you're putting the sun out later, makes it harder to go to bed. I was just talking to someone, the sun's going down at 9:00, and you need to get your kid to sleep at 7:30, 8:00 so they can get the amount of sleep they need. That is almost an impossible task because their circadian rhythms are being pushed later, they can't fall asleep on time. Then you're setting their clocks an hour earlier, so when that alarm clock is going off at 6:00 AM in the morning, it's actually 5:00 AM in the morning. You're squeezing sleep from both sides, and it's basically impossible to get enough sleep. A lot of people think the only problem with daylight savings time is twice a year with the changes, and there are certainly harms related to that. So, a lot of people think if we went to permanent daylight savings time it would be better, and we got rid of those changes. What they don't realize is that permanent circadian misalignment by setting the sun more ahead, at 1:00 to 2:00 instead of at noon causes the sleep and circadian disruption all year round that leads to increased incidents of strokes, of heart attacks, of obesity, of cancer, of suicides, of depression, of worse academic grades. Again, pretty much every outcome you have there that relates to brain health, we have now data that shows that it's worse. And so, we can improve our lives if we can go to permanent Standard Time.  Dr Jones: You convinced me. How about that? If there were any skeptics in the room, I doubt there are any left. We only went to like the fifth floor there, and she... I'm like, "I'm voting for this. Whatever, whatever this bill is, I'm gonna vote for it." So, I'm excited to get to the audience here. Before we get to questions and answers, and we want you to get your questions ready for Dr. Johnson. I do have a couple of trivia questions. And we've been doing this for a little while now on the podcast. The first trivia question actually relates to arts and culture.  Dr Jones: What famous artist used transitions between sleep and wake states to inspire his art? Anybody know?  Guest Speaker 1: Is it Van Gogh?  Dr Jones: Not Van Gogh that I know of. There in the back.  Guest Speaker 2: Picasso.  Dr Jones: Picasso, not that I know of. Right here.  Guest Speaker 3: Salvador Dali.  Dr Jones: Salvador Dali. We have a winner. Thank you for your answer. So apparently, I read this. Salvador Dali would sit in a chair holding onto a metal key and wait until he fell asleep, and it would fall out of his hands and drop into a bowl, and it would wake him up. So, then he would pick it back up, and he would go in and out of sleep trying to generate hypnagogic hallucinations, basically, and he would use that to inspire his art. And you think about his art, maybe that kind of makes sense. All right, now I've got a neurology trivia question. Okay, so maybe we're a little more comfortable with the neurology trivia in here. What is the center in the brain that is responsible for REM sleep atonia?  Guest Speaker 4: The receptor is for erection in the lateral hypothalamus.  Dr Jones: That is not correct. REM sleep atonia. Right here.  Guest Speaker 4: Emilio Malgona, Hyannis, Massachusetts. Dorsal raphe nucleus.  Dr Jones: We'll give you credit for that. Very good. Excellent. So, the-  Dr Johnson: Well, no. That's actually the serotonin. He's talking about another one.  Dr Jones: Oh, I thought I heard, I thought I heard-  Dr Johnson: You heard dorsal  Dr Jones: ... I heard dorsolateral tegmental nucleus of the pod.  Dr Johnson: Not quite.  Dr Jones: You get a prize anyway, sir, just for, just for answering. Thank you very much. All right. So, we're all warmed up here. So, Dr. Albin, what do you think? Should we get some questions from the audience?  Dr Johnson: All right, we've got some questions.  Guest Speaker 5: I have a statement and a question.  Dr Jones: Please tell the podcast your name again, sir.  Guest Speaker 5: Steve Spar, New York City. The tyranny of the morning people. You don't want people, you don't want the sun to go down too late because it'll keep people up longer. I spent my whole life fighting people like you. I am a nighttime person. Why do I have to go to sleep earlier? I want to go to sleep later. I want to wake up later. I don't want to wake up at 7:00 in the morning. I want to wake up at 10:00. There's a certain tyranny that we must use circadian rhythms of the majority, and it persecutes people like me who are night people.  Dr Johnson: So that is a great question.  Guest Speaker 5: What say you?  Dr Johnson: What say me is actually the harms of daylight savings time are actually to the night owls, and don't really affect the morning people. I can still go to sleep on time and get up on time without that pressure of needing to go to work. The night owl people, they can't fall asleep until later. They want to sleep in earlier, but we're forcing them to get up an hour earlier for work and school. And because we're doing daylight savings time, you're not getting the morning light you need, you're getting too much light at night, and you are more sensitive to a delay in your circadian rhythm, which makes you even more of a night owl and increase the degree of social jet lag. So, we actually see that the harms and risks of things like depression, cardiovascular risks are much greater in night owls than they are in normal people or morning larks. And this is again why the risks are the highest for our teenagers, who are essentially all night owls. You're making it harder for them to fall asleep on time. You're making them more and more of a night owl that it becomes more out of line with our standard social schedule. So, what we can do for a night owl is say to our schools, say to life that we want to change our society norms of getting up early. But that has nothing to do with daylight savings time. That has to do with how we make our schedule Dr Jones: All right, next question. And introduce yourself to the audience.  Guest Speaker 6: Sure. I'm Sanjay Rathi from New Haven area, Neurology. Movement disorders, Parkinson's disease, sleep disruptions, sleep-regulating REM, RBD issues, what are your recommendations? And as things get worse, what additional intervention should we do?  Dr Johnson: Yeah, I think it's hard with a lot of our neurodegenerative disorders, it's a two-way sleep. The disorders themselves often worsen sleep quality, have decrease in their sort of circadian amplitudes, and so that can affect sleep ability. And so, trying to do the things that promote sleep, like getting lights down in the evening, keeping things dark and quiet, doing cognitive behavioral sort of therapies if that's needed can all be helpful. Very high incidence of obstructive sleep apnea or other sleep-disordered breathing, whether it's Parkinson's or other neurodegenerative disorders, so evaluating and treating that if need be. And some of these people, especially as they get later on, you may end up considering medication for insomnia because their underlying disorders was causing it and there's, and you're not going to CBTI your way out of it. We do have the new orexin antagonist sleep agents, which are more recommended for older people and probably safer agents than your Z drugs and some of the other sleep meds out there. So, some people should be on some of those meds if their sleep is so disrupted. I've seen some sleep studies where it's basically like wake, sleep, wake, sleep, wake, sleep all night long. And it's like, wow, you really cannot sustain sleep, and we think it's not just a behavioral thing. I think it is part of their underlying Parkinson's and underlying disorders that can really cause major sleep disruption.  Dr Jones: It's a great question. Before we get more from the audience here, Dr. Albin, I'm just curious, you know, you got some questions from online. Don't know if any of those stood out to you. And the other thing is, I think about your practice, Dr. Albin, as a neurointensivist, there's some great content in this issue on how to maintain an adequate sleep environment in the hospital and the importance of that for the acute episode, maybe for some long-term outcomes. When I was reading the article, I didn't really didn't think about the ICU setting. That must be-- what do you do in the ICU?  Dr Albin: Well, we happen to have a question about just that. Dr Jones: Well, there you go  Dr Albin: From Dr. Manners of Baltimore, Maryland. "What meds should I be giving patients in the ICU or the inpatient setting to preserve or recalibrate their sleep-wake cycles? Is there anything that we can do besides just getting them out of bed during the day?"  Dr Johnson: Meds are always hard cause as sleep doctors, we're usually the last one to recommend meds. But there are situations and scenarios where meds may be appropriate. I can't say what's one better than the other, and some of the meds we have probably aren't even available as options in the hospital. So, the, you know, again, the orexin antagonist may be a good class to try to use, but they may not be an option. There was a good study that looked at empowering the patient and whether or not the ICU patients are empowerable. But they give a card to the patients in the hospital and say, "Tell your nurse to turn off my TV and my lights. Do I need all the blood draws all throughout the night, or can it be put off to the morning?" And trying to empower the patient to ask for these things and do some of the behavioral things. And they found that doing that did improve the duration of sleep, did reduce some of the number of awakenings that people ended up having at night. So, I think the ICU is a very particular population where there's a lot of things you can't get rid of. But certainly, turning on the lights, turning off the lights, and trying to limit noises as much as you can, in those night hours, trying to give some sense of a 24-hour day. The other thing is feeding is really important to circadian rhythms. I had a patient that had a brain bleed and, after it, she just her circadian rhythms were just off, and part of it was she was getting tube feeds through the night. So, one of the very first interventions we did was to move her timing of her feeding so that it wasn't in sleep, and that really did help make a difference in getting her back on a pattern, along with light therapy and other behavioral techniques as well.  Dr Jones: It's a great question.  Dr Albin: Absolutely. I mean, I think that validates just that we spend a lot of time actually asking like, "Can we feed people during the day?" Or, "Can we, can we limit the amount of baths that are happening at 3:00 in the morning?" We also had another one from the audience that came from Dr. Lavina Singla of Mississippi, and I think a lot of our patients are asking this question. Is melatonin addictive?  Dr Johnson: Is melatonin safe? Is melatonin addictive? I think with any sleeping aid, people become addictive to what they perceive is the outcome. So, if they said, "This got me to sleep, and now I'm sleeping great, I don't want to come off of it." And so, you get this to meds that are truly addictive, but even meds that aren't felt to have that addiction, there is certainly a behavioral change. And that's a lot of what cognitive behavioral therapy is working with these patients on, is challenging that belief of maybe it isn't the med, maybe it's your internal belief and your worry about doing this. One thing about sleep is sleep happens when you are relaxed and calm and not worried. When you're worried about thinking that thing you're worried about is whether or not you're getting sleep, then you don't sleep. In terms of melatonin, if you don't need to use it, I wouldn't use it. If you are gonna use it, I'd try to use as low doses as possible. Do we know all the risks? We don't know. And especially I think there are potentially more risks in a growing child than, maybe someone who isn't having the same sort of hormonal, needs and growth needs. But then again, if you have, let's say, a kid with autism and melatonin helps him sleep, I'd much rather use melatonin than a lot of other agents, and if that really changes their functionality, that probably is very good for them and better than having them not get sleep. So, I think you have to weigh each individual situation and combine it, especially with the behavioral approaches so that hopefully this is not a long-term addictive thing you're on.  Dr Jones: So, it's complicated. Sounds like it.  Dr Albin: Not a straightforward answer.   Dr Jones: I thought that was gonna be just this hard no, but I guess it is something you have to think about. So, I want to really take a minute here to thank Dr. Karin Johnson, who has been our interviewee for this episode of the Continuum Audio Podcast sleep issue just came out. Really want to encourage our subscribers, our listeners, and our studio audience here to enjoy it. Thank you, Dr. Johnson, for joining us today. I want to give a big round of applause to Dr. Casey Albin for managing this crowd. Thank you to our listeners. Thank you to our subscribers. Thank you to you all for coming today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.   

Our podcast features two guests described by our podcast host, Dr Jane Barratt as positive disrupters or by themselves jokingly as radical trialists. What's clear is that something significant is on the horizon: mounting evidence linking acute respiratory infections and non-communicable diseases (NCDs). Cardiovascular diseases, diabetes, cancers, asthma and COPD all fall into the category of NCDs that can be exacerbated by respiratory infections. In turn, these conditions can exacerbate the viral infections causing flu, COVID and RSV.We know that vaccinating against a respiratory infection reduces the burden of NCD management on health care. But the WHY and HOW remain unclear. What's needed is research into pathogen-specific mechanisms, clinical meaningful endpoints for prevention and better risk-stratification. Listen to eye-opening findings from the FLUNITY-HD trial and why respiratory infections can be described as systemic stress tests.In a highly informative and engaging conversation, brimming with facts and insights, Marco Goeijenbier (ESWI Board Member, intensivist at Spaarne Gasthuis and Senior Scientist at Erasmus MC) and Tor Biering-Sørensen (cardiologist and Founding Head of the Center for Translational Cardiology in Copenhagen) discuss what we know, and where science still needs to mature in this pioneering field.

Wildfire smoke is affecting communities across southwest Washington, with risks especially high for those with asthma, COPD, heart conditions, and allergies. PeaceHealth outlines steps residents can take now, from limiting outdoor exposure to keeping rescue medications on hand. All PeaceHealth facilities are open and operating with enhanced air filtration systems. https://www.clarkcountytoday.com/news/southwest-washington-residents-should-exercise-care-as-wildfire-smoke-builds-in-region/ #WildfireSmoke #SouthwestWashington #ClarkCounty #AirQuality #PeaceHealth #PublicHealth #WashingtonState #PacificNorthwest

Many people assume becoming breathless is simply part of getting older - but it could be a sign of Chronic Obstructive Pulmonary Disease (COPD), a progressive lung condition that is often diagnosed too late. Michelle Martin speaks with Dr Jim Teo, Respiratory Physician at O2 Healthcare Group, about why COPD is frequently mistaken for normal ageing, the warning signs people shouldn't ignore, and how delayed diagnosis can dramatically reduce lung function. Dr Teo shares the story of a 75-year-old patient whose lung capacity fell to just 30%, explains how pulmonary rehabilitation can improve quality of life. Listeners share their pressing questions.See omnystudio.com/listener for privacy information.

Wildfire smoke used to feel like someone else's problem. Now it can show up on air quality alerts hundreds of miles from any actual fire, and for anyone with asthma, that hazy sky can mean real trouble breathing. In this episode, Kortney and Dr. Gupta are joined by Dr. Neelu Tummala, an ENT physician and climate health expert, to talk about why wildfires are getting more frequent and intense, what is actually in wildfire smoke, and the everyday steps that can protect your lungs, your family, and even your pets. What we cover in this episode about wildfire smoke and asthma Why wildfires are intensifying. Warmer, drier conditions have extended the wildfire season by about a month compared with 35 years ago. What's actually in the smoke. PM2.5 particles make up most of wildfire smoke's mass and are small enough to slip past your body's natural filters. How it affects your body. Smoke can irritate the nose, throat, and ears before it ever reaches your lungs, and it can also affect heart and brain health. Who's most at risk. Babies, kids, older adults, pregnant women, and anyone with asthma, COPD, or heart disease need extra caution. How to protect yourself. Check the AQI, wear a well-fitted N95, run air purifiers, and keep pets indoors during smoky days. More resources How Wildfire Smoke Can Worsen Your Asthma How Climate Change Impacts Allergies and Asthma Find out about your local air quality: Asthma and Allergy Forecast American Lung Association: State of the Air report, PDF version Wildfires and asthma from the American Lung Association NYC Resources: Cooling options and Cooling centers This podcast is made in partnership with Allergy & Asthma Network

Nate Stasko, CEO of Vast Therapeutics, is developing a novel nitric oxide-releasing therapy to treat chronic respiratory diseases, particularly fibrosis bronchiectasis, which is frequently misdiagnosed as asthma or COPD. Their lead drug candidate is a dual-mechanism therapy that is delivered to the lungs via a nebulizer to target both infection and inflammation with the potential to eradicate pathogens rather than just suppressing them. This approach, in early trials, is showing excellent tolerability and eliminates the need for chronic antibiotic use, which carries the risks of toxicity and contributes to antibiotic resistance.  Nate explains, "At Vast Therapeutics, our main idea and goal as a company is to come up with better solutions for the 500 million people worldwide who suffer from chronic respiratory disease. And there is a new disease getting a lot of attention that we're targeting with our lead program called bronchiectasis, and it's often been misdiagnosed as asthma or COPD. And now over a million patients in the US are being diagnosed with bronchiectasis. And the whole campaign is to teach physicians and the whole medical community to suspect this disease over some of these other misdiagnosed diseases."  "Traditionally, patients have been managed with either antibiotics to calm down the infection, but you know the problems of chronic antibiotic use- the liver toxicity, kidney toxicity, and hearing loss associated with long-term antibiotic use are just bad for these patients. Not to mention we have the global problem of antibiotic resistance. And so giving a 52-week course of therapy of antibiotics is less than ideal. And then recently, just last year, there's some hope for these patients where there was a new drug approved called brensocatib, which was the first drug ever approved for bronchiectasis by the FDA. And so now it targets the inflammation." "Having the ability to target two mechanisms of action would be the best therapy. And that's actually what Vast is developing. We're using the body's own ability to make and produce nitric oxide, which is a miracle molecule. And we're delivering nitric oxide back to these patients to target both the infection and inflammation at the same time and improve the overall standard of care for these patients."  #VastTherapeutics #Bronchiectasis #Pulmonology #NitricOxide #RespiratoryMedicine #AntimicrobialResistance #ALX1#ChronicLungDisease #HealthcareInnovation #ClinicalTrials vasttherapeutics.com Listen to the podcast here

Nate Stasko, CEO of Vast Therapeutics, is developing a novel nitric oxide-releasing therapy to treat chronic respiratory diseases, particularly fibrosis bronchiectasis, which is frequently misdiagnosed as asthma or COPD. Their lead drug candidate is a dual-mechanism therapy that is delivered to the lungs via a nebulizer to target both infection and inflammation with the potential to eradicate pathogens rather than just suppressing them. This approach, in early trials, is showing excellent tolerability and eliminates the need for chronic antibiotic use, which carries the risks of toxicity and contributes to antibiotic resistance.  Nate explains, "At Vast Therapeutics, our main idea and goal as a company is to come up with better solutions for the 500 million people worldwide who suffer from chronic respiratory disease. And there is a new disease getting a lot of attention that we're targeting with our lead program called bronchiectasis, and it's often been misdiagnosed as asthma or COPD. And now over a million patients in the US are being diagnosed with bronchiectasis. And the whole campaign is to teach physicians and the whole medical community to suspect this disease over some of these other misdiagnosed diseases."  "Traditionally, patients have been managed with either antibiotics to calm down the infection, but you know the problems of chronic antibiotic use- the liver toxicity, kidney toxicity, and hearing loss associated with long-term antibiotic use are just bad for these patients. Not to mention we have the global problem of antibiotic resistance. And so giving a 52-week course of therapy of antibiotics is less than ideal. And then recently, just last year, there's some hope for these patients where there was a new drug approved called brensocatib, which was the first drug ever approved for bronchiectasis by the FDA. And so now it targets the inflammation." "Having the ability to target two mechanisms of action would be the best therapy. And that's actually what Vast is developing. We're using the body's own ability to make and produce nitric oxide, which is a miracle molecule. And we're delivering nitric oxide back to these patients to target both the infection and inflammation at the same time and improve the overall standard of care for these patients."  #VastTherapeutics #Bronchiectasis #Pulmonology #NitricOxide #RespiratoryMedicine #AntimicrobialResistance #ALX1#ChronicLungDisease #HealthcareInnovation #ClinicalTrials vasttherapeutics.com Download the transcript here

Please join us for this new moon Arcturian Healing Method healing session where we address the physiological and energetic functioning of the lungs.  We will be applying advanced Arcturian Healing Method frequencies to healing the lungs, the trachea (air tube), the mouth, and the teeth.  The energies will also work down to the cellular levels of the gas exchange occurring in the lungs in the small air sacs called the alveoli.  This session is good for full functioning of the lungs and also to support healing for illnesses such as chronic obstructive pulmonary disease (COPD), asthma, lung infections (pneumonia and tuberculosis), lung cancer, and smoking cessation.  There will also be a unique 10 minute download from the Arcturians for lung health that will occur towards the end of the healing session. The healing session will last 45 minutes.After a short integration break, we will be working with an advanced form of the Arcturians known as the Arcturian Guard.  These are the Arcturian Beings that have the quality of strength, protection, and might.  We will be doing a group as well as individual pillar of light meditation with these qualities and energies of the Arcturians to bring world peace for the events on the earth and to avoid or curtail in particular violence and war on the planet.  The new moon energies will also be utilized to help set new intentions for the month and year.Please join to reinvigorate your physical, energetic, emotional, mental, causal, spiritual, and divine bodies with the breath of life and also to continue to assist the planet to have its best soul timeline for all.

What is your sleep really telling you about your long-term health? In this episode, Peggy Smedley sits down with Dr. Pierre Escourrou, Senior Medical Advisor at Withings and practicing cardiologist, to unpack groundbreaking research linking nighttime breathing patterns to arterial aging — and what that means for your cardiovascular health. They explore: How sleep apnea and snoring accelerate arterial stiffness Why a single night of sleep data leads to 20% misdiagnosis rates — and how continuous monitoring changes that The power of connected device ecosystems (IoT) over standalone wearables How AI + IoT data is shifting medicine from treatment to prevention What conditions — including hypertension, heart failure, COPD, and menopause — may be detectable years earlier using devices like the Withings Sleep Analyzer and smart scale The regulatory and insurance hurdles still standing in the way Whether you're a health tech enthusiast, a clinician, or someone who just wants to understand their sleep data better, this episode is packed with insights you won't want to miss. Learn more at withings.com 

The smoke that's been inundating Wisconsin is impacting everything that takes a breath - including plants. Kiley Allan talks with Brent Elliot, Director at Stratford Area Fire Department EMS. He says the area is experiencing thick, poor air quality due to Canadian wildfire smoke, which was forecasted by the National Weather Service alongside high heat and humidity. Individuals with respiratory illnesses (asthma, COPD, emphysema) and cardiovascular conditions are at high risk, as poor lung oxygenation directly strains the heart and body tissues. Individuals should immediately rest if they experience "the dangerous triad": feeling winded/struggling to breathe, feeling dizzy or lightheaded (signs of low oxygenation), or experiencing heavy chest tightness. Those at risk should stay in air-conditioned indoor spaces. If outdoors, it is advised to stay hydrated, spend 15–20 minutes of every hour in shaded shelter (such as a tent or an air-conditioned vehicle), and monitor companions. Event medical staff are equipped to handle respiratory distress early with roaming teams, air-conditioned facilities, and oxygen therapy, preventing minor symptoms from escalating into emergencies. Not much smoke in our forecast today! Stu Muck says the cooler temperatures we're enjoying today also give us an air advisory break. Muck says this pattern will stick around for about 36 hours, and then it's back to more heat and potentially more smoke. Ice cream provides a nice, cool treat to break the heat of July. Teri Barr reports that it's also acting as a conversation starter for the 79th Alice in Dairyland, Anastasia Poull. Poull is using ice cream as the platform to educate consumes about Wisconsin's roll in delivering the tasty treat. Beef cattle supplies will continue to be tight into 2027. That's driving live animal prices even higher. Pam Jahnke reports that the chair of the World Ag Outlook board is expecting those prices to keep ratcheting up into 2027. One of the elements that attracts people to Wisconsin is our green space, including our forests. What you may not realize is that more than 56% of all our forests in the state are owned by private land owners. That's between 9-11 million acres. If those land owners don't have a plan on how to maintain and manage those lands, there's a problem. Kiley Allan introduces us to Tony Johnson, Forestry Outreach Specialist with UW-Madison. He says only 25% of Wisconsin woodland owners have a written forest management plan. His goal is to help others create a blueprint for getting what they want out of their woods.See omnystudio.com/listener for privacy information.

This week, I started off mentioning the smoky skies due to the Canadian wildfires, and that it’s not the best idea in the world to spend a lot of time outdoors while it’s here. It can definitely affect people already compromised by allergies, asthma, COPD, and other lung conditions. Then we got into what’s going […]

Department Chair of Emergency Medicine at Cook County Health Dr. Trevor Lewis joins the Lisa Dent Show to discuss how the poor air quality will affect people’s health and who’s most at risk of falling ill given the current conditions. He advises asthmatics and COPD patients to either use their inhaler or seek immediate medical […]

Curious how AI can query your enterprise data without moving it or making things up? AWS and Teradata break down a trustworthy analyst agent built for real production use.Topics Include:Neha Wadhera (AWS) introduces Trinath Yarlagadda and the Teradata Analyst AgentEnterprise AI data prep is costly, stalling most orgs at experimentationAgent answers plain-English questions via traceable SQL, zero data movementBarrier removal drives 3.7x ROI and 40% productivity gainsHealthcare demo setup: hospital COPD readmissions, ~$10K cost per incidentFour design principles: traceability, no data movement, deterministic-first, governance as codeMain orchestrator agent plans, writes SQL, calls Teradata MCP serverComplex questions escalate to a context-isolated data scientist agentBuilt on Claude Agent SDK, running Bedrock Claude Sonnet/Haiku/OpusLive demo: COPD readmission rates explored through iterative agent reasoningDelegation demo: data scientist agent runs in-database analysis, surfaces factorsPre/post tool hooks log every step and cost to CloudWatchAgent hosted on Amazon Bedrock AgentCore, fully serverless and scalableAgentCore delivers runtime, memory, identity, and observability out of the boxLessons learned: guardrails first, deterministic ops, multi-agent registry, ongoing evaluationParticipants:Trinath Yarlagadda – Principal Solution Architect – Agentic AI, TeradataNeha Wadhera – Sr Solutions Architect, Amazon Web Services See how Amazon Web Services gives you the freedom to migrate, innovate, and scale your software company at https://aws.amazon.com/isv/

New research reveals why lowering the weight — not just lifting it — may be the most valuable, most overlooked element of resistance training. A new systematic review and meta-analysis published in Sports examines the comparative benefits of eccentric versus concentric training across healthy adults, older adults and clinical populations. For operators, the findings challenge a widespread blind spot in how strength training is coached and programmed on the gym floor. This Episode Covers: - Eccentric vs. concentric training: what the latest meta-analysis reveals - Why lowering the weight may matter more than lifting it - The link between power, rate of force development, and longevity - How eccentric training benefits clinical populations, including COPD patients - What this means for how trainers should be coaching strength work

In this episode, we sit down with Professor Jay Horvat from the University of Newcastle and the Hunter Medical Research Institute (HMRI) to discuss why lung health is fundamental to overall wellbeing and how emerging research is uncovering surprising new influences on respiratory disease. Professor Horvat explains the challenges faced by Australians living with asthma, chronic obstructive pulmonary disease (COPD), and particularly those managing both conditions at the same time. We explore groundbreaking research investigating how the body's metabolism - including factors such as blood sugar levels, cholesterol and excess abdominal fat - may contribute to lung inflammation and breathing difficulties. Professor Horvat discusses how a better understanding of these connections could lead to new treatments, lifestyle interventions and improved outcomes for people with chronic respiratory disease.See omnystudio.com/listener for privacy information.

Send us Fan Mail#eveningprayer #pray #jesus #god #christianprayer #HolySpirit Evening Prayer (Thank You LORD; Forgiveness; Pneumonia; COPD; Diabetes; Malaria; Praise)Thank you for listening, our heart's prayer is for you and I to walk daily with Jesus, our joy and peaceaimingforjesus.comYouTube Channel https://www.youtube.com/@aimingforjesus5346Instagram https://www.instagram.com/aiming_for_jesus/Threads https://www.threads.com/@aiming_for_jesusX https://x.com/AimingForJesusTik Tok https://www.tiktok.com/@aiming.for.jesus

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we delve into a series of transformative events shaping our industry, starting with a significant regulatory milestone. Vera Therapeutics recently achieved FDA accelerated approval for Trutakna, a groundbreaking treatment for IgA nephropathy. This approval not only provides new hope for patients suffering from this chronic kidney disease but also highlights the innovative approach targeting APRIL and BAFF pathways, crucial in immune system regulation. The drug's accelerated approval is particularly noteworthy as it offers earlier access to promising therapies while further trials solidify its benefits. This positions Vera Therapeutics against industry giants like Novartis and Otsuka in nephrology therapeutics, highlighting the competitive landscape within this sector. The FDA's expedited pathways are increasingly facilitating quicker access to life-saving drugs, aligning regulatory processes with scientific advancements to address unmet medical needs. The spotlight on fusion proteins in tackling autoimmune and renal disorders could signal a broader trend in therapeutic development. In parallel, AstraZeneca has made waves by entering into a major licensing agreement with Sino Biopharmaceutical for their COPD candidate TQC3721. This $1.9 billion deal, with a $200 million upfront payment, exemplifies how global collaborations are becoming pivotal in expanding market reach. By focusing on respiratory diseases, AstraZeneca is strategically positioning itself to enhance treatment options for COPD patients worldwide, reflecting an industry-wide movement towards leveraging regional expertise in drug commercialization. Meanwhile, Evonik's $100 million investment in an Indiana API manufacturing plant marks a strategic effort to bolster domestic production capacities post-pandemic. This investment underscores the rising demand for Contract Development and Manufacturing Organization (CDMO) services, emphasizing supply chain resilience—an increasingly critical factor as biotech firms seek reliable production partners. On the clinical trial front, Satellos Bioscience has reported promising Phase 1 data for SAT-3247, its Duchenne muscular dystrophy candidate. This AAK1 inhibitor demonstrates potential in promoting muscle regeneration, a development that could significantly alter treatment paradigms for this progressive neuromuscular disorder. If further trials confirm these findings, it could revolutionize therapeutic approaches for rare diseases. Financially, Leo Cancer Care's recent $65 million Series D funding is set to advance its upright radiotherapy treatment system. Such innovations aim to improve precision and outcomes in cancer therapy, at the intersection of technology and patient care. Similarly, MeiraGTx's securing of up to $400 million from Oberland Capital underlines ongoing confidence in gene therapies targeting rare ophthalmological conditions. Strategic maneuvers continue to reshape industry landscapes with mergers like that of Caidya and Simbec-Orion forming a global CRO platform aimed at enhancing research capabilities across oncology and rare diseases. Such consolidations reflect broader trends towards operational efficiencies and scaling research capabilities globally. Amidst these developments, quality control remains paramount as evidenced by Amgen's recall of its heart failure drug due to quality concerns. Such challenges reiterate the importance of stringent quality assurance throughout production processes in safeguarding patient safety. Vertex's acquisition of Crinetics for $10 billion marks another strategic expansion into "white space blockbuster opportunities," illustrating how M&A activity is driving companies to bolster pipelines and capitalize on emerging scientific advancements. These developments collectively underscore the dynamic nature of the pharmaceutical and biotech industries as they navigate complex regulatory landscapes, financial recalibrations, and scientific breakthroughs. As companies strive towards more effective and accessible treatments across various therapeutic areas, their ability to adapt to these challenges remains crucial in shaping the future of healthcare delivery. Thank you for tuning into Pharma Daily. Stay informed with us as we continue to bring you the latest insights from the world of pharmaceuticals and biotechnology.Support the show

Broadcast from KSQD, Santa Cruz on 7-02-2026: Dr. Dawn devotes the first half of the show to a nuanced defense of GLP-1 receptor agonists, arguing the polarized debate treats obesity as a moral failure rather than a physiological one. She recounts the "Marilyn Monroe dress" moment that transformed semaglutide from diabetes drug into elite cosmetic tool, and pushes back on the puritanical framing that behavior change must be earned rather than pharmacologically enabled—noting we don't apply this logic to antihypertensives or statins. Dr. Dawn catalogs visceral fat as a genuine endocrine organ producing over 17 hormones, most of which drive self-perpetuating growth: leptin (this satiety hormone at high levels disables it's own brain receptor), IL-6, TNF-alpha (blocks insulin), resistin (increases insulin resistance and inflammation), PAI-2 (blocks clot breakdown, raising cardiovascular risk), retinol-binding protein 4 (impairs muscle glucose uptake), chemerin (recruits macrophages and directs fat to the belly), and visfatin. Only adiponectin declines with rising visceral fat. It improves insulin sensitivity, suppresses hepatic gluconeogenesis, and blocks IL-6 . Dr. Dawn describes GLP-1's neurobiological action: receptors in the hypothalamus, brainstem, hippocampus, and mesolimbic reward system, with the drugs quieting the brain's salience network so food loses its intrusive pull. Taste buds shift, sweet and salty become muted, and reward circuits stop firing on cheat foods—creating a window during which behavioral change becomes possible. Dr. Dawn frames group support through self-determination theory (autonomy, competence, relatedness), arguing GLP-1s create the cognitive bandwidth for behavioral programs to succeed. A Tufts study of patients discontinuing after 10% weight loss found those enrolled in behavioral support programs regained about three times less weight than usual-care controls, outperforming even medically-tailored meal plans. Group engagement doubled the time patients stayed on the medication. A November 2025 Nature study piggybacked on deep brain stimulation research at Penn. Electrodes implanted in the nucleus accumbens of post-bariatric patients recorded low-frequency brain activity surges during food-noise episodes on drug free patients. A third participant who started tirzepatide showed complete silencing of that signature—the first direct electrical confirmation that GLP-1s suppresses compulsive food thoughts in the reward center. RNA sequencing of adipose tissue from 25 obese patients before and after bariatric surgery, compared to 24 lean controls, revealed persistent epigenetic changes even after weight loss. Lipid-associated inflammatory macrophages drop but retain some of their pro-inflammatory epigenetics, explaining the well-known slippery slope back to obesity—and why Dr. Dawn suggests GLP-1s may work best as intermittent tools when behavioral maintenance starts slipping. An emailer asks about long-term smoking versus vaping data. Dr. Dawn notes there is no long-term data yet, but short-term evidence shows e-cigarettes contain nicotine, propylene glycol, reactive oxygen species, and nitrosamines, producing spirometry readings similar to mild COPD in otherwise-healthy vapers. Vaping over a year raises stroke relative risk by 1.62 and nearly doubles MI risk, and combining smoking and vaping produces a multiplicative rather than additive harm. Data on cancer will take decades to emerge. Researchers built a functioning underwater breathing apparatus for cockroaches with electrodes attached to brain and sensory organs allowing remote-controlled direction while preserving natural obstacle-navigation autonomy. The 10mm × 10mm sponge-based oxygen tank uses magnesium dioxide catalyzing hydrogen peroxide breakdown, delivering oxygen through silicone tubes to the roach's spiracles for up to three hours underwater. Deployemenet will improve search-and-rescue in flooded and collapsed structures where dogs cannot reach. A Science Advances paper from Yong Lin Kong's lab at Rice University describes 3D-printing electronic circuits directly onto living tissue. Researchers achieved microwave-focused annealing at sub-200-micrometer resolution. By selectively heating only conductive ink particles (copper, silver, gold) without damaging surrounding tissue, the technique enables printing circuits onto 3D-printed heart valves, tracheas, and ear scaffolds, potentially creating combined graft-and-sensor implants, ingestible diagnostic devices, and perhaps even decorative electronic tattoos. A single-shot reformulation of zanamivir (originally the inhaled flu drug Relenza) provided 76.1% flu protection in a 5,000-participant trial—far exceeding the roughly 40-45% offered by annual flu vaccines. Because zanamivir targets neuraminidase in a way that inactivates it if the virus tries to mutate around the drug, trapping newly-made viral copies inside their host cells, this approach works across all flu strains and could bypass the annual guessing game of trivalent vaccine formulation.

Are your blood markers telling you and your doctor the whole story? Chronic inflammation is the silent driver behind nearly every major disease, and the good news is that your lifestyle choices decide the outcome. Don't wait for a life altering diagnosis to take action.In this episode of Salad With a Side of Fries, host Jenn Trepeck breaks down how blood markers move, how preventable diseases develop, and why epigenetics means your genes are not your fate. If you have ever felt like your health was out of your hands, this episode will change the way you think about your daily choices.What You Will Learn in This Episode:✅ Why chronic inflammation is considered the root cause of virtually every major illness and how oxidative stress accelerates disease progression in the body.✅ How epigenetics reveals that your lifestyle choices, not just your genetics, impact disease-related genes.✅ What specific blood markers to track for heart disease, type 2 diabetes, liver disease, and kidney disease, and realistic timelines for improving them.✅ How to advocate for yourself in a medical system still rooted in a prescription-first approach, and how to ask your doctor for the time and space to make disease prevention changes first.The Salad With a Side of Fries podcast, hosted by Jenn Trepeck, explores real-life wellness and weight-loss topics, debunking myths, misinformation, and flawed science surrounding nutrition and the food industry. Let's dive into real-life wellness and weight loss, including drinking, eating out, and skipping the grocery store.TIMESTAMPS:00:00 Preventable diseases don't have to be your story and what blood markers can and cannot tell you05:55 The most common diseases: heart disease, type 2 diabetes, and cancer and how they are linked to lifestyle choices06:46 Epigenetics explained: how your daily habits turn disease risk genes up or down17:21 Lifestyle choices, from gut health to the brain to the endocrine system, impact every organ system20:10 Oxidative stress and free radicals explained: the science behind chronic disease25:01 Lifestyle choices that support overall health rather than disease and healthcare 3.0, being your own advocate32:12 Discussion of food with no labels; vegetables, fruit and lean meat36:19 Movement as disease prevention: why sitting all day quietly drives chronic illness more than we realize41:06 Longevity, community, connection, sleep, and stress management as overlooked pillars of health42:05 Blood marker timelines: how fast insulin, A1C, cholesterol, and blood pressure respond to lifestyle changesKEY TAKEAWAYS:

CHEST July 2026, Volume 170, Issue 1 CHEST® journal's Editor in Chief Peter Mazzone, MD, MPH, FCCP, highlights key research published in the journal CHEST July 2026 issue, including an analysis of the association between inhaling marijuana and asthma attacks, an exploration of the efficacy and safety of ensifentrine in Chinese patients with COPD, and more.  Moderator:    Peter Mazzone, MD, MPH, FCCP

In this episode of the Industry Matters Respiratory Edition, recorded live at VGM Heartland 2026, host Boone Lockard, VP of HME, Respiratory, and Wellness at VGM, sits down with Dr. Colleen Lance, Chief Medical Officer at React Health, and Bill Shoop, CEO of React Health, to unpack the seismic shifts in the NIV and ventilation market following the release of the new National Coverage Determination (NCD) for COPD. They discuss what changed in policy, how providers have adapted (or struggled), the role of CO2 requirements and adherence monitoring, best practices for patient care, and what the future of NIV looks like across the full spectrum of chronic respiratory disease. Whether you're an HME provider, prescriber, or manufacturer, this conversation offers practical insights on partnership, education, and navigating change in a rapidly evolving regulatory landscape.Watch the video version on YouTube: https://www.youtube.com/watch?v=1sKodXo-J5k

For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/learn/course/recent-research-into-biologics-in-asthma-10830Program DescriptionThis podcast activity provides an in-depth review of several recent trials in severe asthma management, highlighting the ongoing shift in asthma precision medicine towards identifying the right patients for the right treatments. Clinicians will examine clinical data from the NIMBLE trial (depemokimab), alongside the WAYFINDER trial (tezepelumab), as well ZEPHYR 5 (benralizumab), REMOMEPO (mepolizumab), VESTIGE (dupilumab) and VALLIANT (verekitug). This activity will grant clinicians critical insights to move beyond simple exacerbation reduction and precisely align advanced biologic therapies with the underlying cellular biology driving each patient's symptoms.Educational ObjectiveAt the conclusion of this activity, participants should be better able to:Review recent updates in the asthma literature, including recent guideline revisions and evolving clinical trial data for newer biologic therapies.Accredited ProvidersThe National Association for Continuing Education in partnership with the Association for Pulmonary Advanced Practice Providers (APAPP).The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The National Association for Continuing Education designates this enduring material for a maximum of 0.25 Physicians should claim only the credit commensurate with the extent of their participation in the activity. The National Association for Continuing Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 121222. This activity is approved for 0.25 contact hours (which includes 0.25 hours of pharmacology).FacultyCedric Rutland, BS, MD, FCCPVolunteer FacultyUniversity of CaliforniaPulmonary Critical Care Internal Medicine, ProducerRutland Medical GroupNewport Critical Care PhysiciansLake Forest, CADr. Rutland has disclosed the following financial relationships:Consultant: Sanofi (asthma, diabetes, NP, RSV, AD), Boehringer Ingelheim (IPF, PPF), Regeneron (asthma, diabetes, NP, RSV, AD), Chiesi (asthma), Baxter (bronchiectasis), Insmed (bronchiectasis), AstraZeneca (asthma, cough)Advisor/Advisory Board: Sanofi (asthma, AD, NP), Regeneron (asthma, AD), Chiesi (asthma), Boehringer Ingelheim (IPF, PPF), AstraZeneca (asthma, cough)Speaker: Sanofi (asthma, NP, AD, AFRS, urticaria, EoE), Regeneron (asthma, NP, AD, AFRS, urticaria, EoE), Boehringer Ingelheim (IPF, PPF), AstraZeneca (asthma, cough), Chiesi (asthma), Baxter (bronchiectasis)These relationships have ended within last 24 months:Consultant: GSK (asthma, cough, RSV)Advisor/Advisory Board: GSK (asthma, cough, RSV)Speaker: GSK (asthma, cough, RSV)Diego J. Maselli, MD, FCCP, ATSFProfessor and ChiefDivision of Pulmonary Diseases & Critical CareUT Health at San AntonioDirector, Respiratory Care, University Health SystemDirector, Severe Asthma Program, University Health SystemSan Antonio, TXDr. Maselli has disclosed the following financial relationships:Consultant: AstraZeneca (asthma, COPD), Sanofi/Regeneron (asthma, COPD), GSK ( asthma, COPD), Amgen (asthma, COPD), Insmed (bronchiectasis)Speaker: GSK (asthma, COPD), AstraZeneca (asthma, COPD), Amgen (asthma, COPD), Sanofi/Regeneron (asthma, COPD)All of the relevant financial relationships listed for these individuals have been mitigated.Nurse Planner and Peer ReviewerMarjorie Crabtree, DNP, FNP, ANPHaymarket Medical EducationSteering CommitteeNurse Practitioner Healthcare FoundationAccredited Provider Program DirectorBellevue, WADr. Crabtree has no relevant conflicts of interest with any ACCME-defined ineligible company.Accredited Provider DisclosureNACE staff has no relevant financial relationships to disclose.Intended AudiencePulmonology, allergy/immunology, and critical care clinicians (physicians, nurse practitioners, and physician associates), as well as primary care and geriatric medicine clinicians caring for patients with asthma.Commercial SupportersThis activity is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc and Sanofi.Please visit  http://naceonline.com to engage in more live and on demand CME/CE content.

Hot, humid summer weather can make breathing more difficult—especially for people living with asthma or COPD. In this episode, Dr. Aliaksandr Ramaniuk,Summa Health pulmonologist explains what happens in your lungs during extreme heat and shares practical tips to help you stay safe, recognize early warning signs, and prevent flare-ups. Learn how simple steps—like checking air quality, staying hydrated, and planning ahead—can help you enjoy summer with confidence.  Schedule an Appointment with Dr. Ramaniuk 

SUMMARY Arundhati Parmar speaks with Jill Schwartz-Chevlin, Chief Medical Officer at Vinca, about the evolution of palliative care from a hospital-based, end-of-life service to a community and home-based model for patients living with serious illness. Jill explains how Vinca grew from an advanced care planning platform into a value-based palliative care company serving patients across five states, primarily through Medicaid and Medicare Advantage plans. The conversation covers the critical distinction between palliative care and hospice, the cost savings data that health plans are paying attention to, and what it will take for Medicare to finally build a sustainable reimbursement model for the specialty. KEY TAKEAWAYS Palliative care is not hospice. It is symptom management and whole-person support for patients still pursuing active treatment for serious illness, including cancer, COPD, and advanced heart failure. More than 75% of hospitals now have palliative care teams, but their positioning around end-of-life discussions has created a widespread misconception that palliative care equals dying. Home-based palliative care through Vinca produces a 42% reduction in ER admissions and a 53% reduction in hospitalizations. Only three states (California, Hawaii, and New Jersey) have established a Medicaid benefit specifically for palliative care. Traditional Medicare offers no such benefit. The current fee-for-service model for palliative care is not sustainable. Most palliative care programs linked to hospices survive only because the hospice subsidizes them. KEYWORDS palliative care at home, home-based palliative care, serious illness management, palliative care vs hospice, Vinca health, value-based palliative care, Medicaid palliative care benefit, Medicare Advantage palliative care, community palliative care, advanced care planning, hospice length of stay, ER reduction palliative care, whole-person care, serious illness, home health palliative care, CMO interview healthcare, palliative care reimbursement, MedCity Pivot podcast Links and resources  Connect with Arundhati Parmar  aparmar@medcitynews.com  Arundhati Parmar (@aparmarbb) on X MedCity News EPISODE HIGHLIGHTS [00:02:04 – 00:02:36]  Jill defines palliative care: symptom relief, patient wishes, team-based approach [00:03:11 – 00:03:46]  Why hospital palliative care teams created the end-of-life association [00:06:13 – 00:07:06]  Vinca's 15-year journey from advanced care planning to full palliative care services [00:11:43 – 00:12:07]  The data: 42% ER reduction, 53% hospitalization reduction [00:12:52 – 00:13:31]  Patient story: metastatic pancreatic cancer, golf one month ago, ER the next [00:18:47 – 00:19:29]  Jill clarifies the hospice misconception: 90% of hospice care happens at home [00:22:50 – 00:24:10]  Why Medicare's fee-for-service model for palliative care is failing and what should replace it

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we delve into the dynamic landscape of the pharmaceutical and biotech sectors, where significant scientific advancements, regulatory shifts, and strategic business maneuvers are reshaping patient care and therapeutic approaches. A pivotal moment recently unfolded with Ipsen's acquisition of Kartos Therapeutics for up to $1.75 billion. This strategic move adds navtemadlin, a promising myelofibrosis candidate, to Ipsen's oncology pipeline. Navtemadlin is a small molecule inhibitor targeting MDM2, a crucial regulator of the tumor suppressor p53. This acquisition reflects a strategic emphasis on expanding therapeutic options in hematologic oncology, aiming to improve outcomes for patients with myelofibrosis—a rare and debilitating bone marrow disorder. In regulatory advancements, Viridian Therapeutics achieved a significant milestone with FDA approval of Lumvoa (veligrotug-vvze) for treating thyroid eye disease across both active and chronic stages. This monoclonal antibody targets IGF-1R, addressing an unmet need in autoimmune conditions by potentially altering disease progression and improving patient quality of life. Concurrently, AstraZeneca and Daiichi Sankyo's Enhertu (trastuzumab deruxtecan) secured EU approval for HER2-positive metastatic solid tumors after successful Phase 2 trials. Enhertu's role as an antibody-drug conjugate highlights a breakthrough in targeting cancer cells more precisely while sparing healthy tissues, underscoring the growing importance of personalized medicine in oncology. The clinical trial landscape saw pivotal results with AstraZeneca's efzimfotase alfa demonstrating efficacy in Phase 3 trials for hypophosphatasia—a rare bone disease characterized by defective bone mineralization due to enzyme deficiencies. This protein therapy aims to replace deficient alkaline phosphatase enzymes, offering hope for improved skeletal outcomes in affected children. Furthermore, BridgeBio Pharma's infigratinib showed promise in Phase 3 trials for treating achondroplasia by demonstrating significant growth improvements. As a fibroblast growth factor receptor (FGFR) inhibitor, it underscores the potential of targeted therapies in addressing genetic disorders. On the business development front, Zymeworks' acquisition of Theravance for $929 million adds the COPD drug Yupelri to its portfolio alongside lucrative royalty arrangements. Yupelri is a long-acting muscarinic antagonist (LAMA) that offers once-daily bronchodilation for COPD patients. This strategic move bolsters Zymeworks' respiratory franchise and highlights the ongoing consolidation trend in the industry as companies seek growth through diversification and enhanced therapeutic offerings. In parallel, Talawar Therapeutics is planning a $285 million SPAC merger to advance its bispecific antibody for eczema treatment. Similarly, Lycia Therapeutics raised $75 million in Series D funding to progress its extracellular protein degrader pipeline aimed at autoimmune diseases. These investments signal robust interest in novel modalities such as bispecific antibodies and targeted protein degradation technologies that promise new therapeutic avenues. However, not all news was positive. The FDA rejected Sobi's NASP (pegadricase) application due to manufacturing issues, highlighting ongoing challenges firms face in meeting regulatory standards for complex biologics. Additionally, Evommune's Evo756 failed its primary endpoint in Phase 2b trials for chronic spontaneous urticaria, illustrating the high-risk nature of drug development. Looking at the broader industry trends, Roche's launch of Axelios 1 represents a strategic push into the gene sequencing arena, directly challenging Illumina's market dominance. As precision medicine continues to gain traction, advancements in gene sequencing technologies are likely to play an instrumental role in personalized medicine strategies, offering more tailored treatment options based on genetic profiles. Finally, we see significant shifts driven by recent regulatory changes and scientific breakthroughs across the sector. The FDA's revised stance on rare disease drug approval criteria could expedite processes for companies like Skyhawk Therapeutics and Biohaven, providing new opportunities to bring treatments to market more swiftly. These regulatory adjustments reflect an evolving landscape where innovation is poised to meet unmet medical needs more efficiently. In conclusion, these developments underscore a dynamic pharmaceutical and biotech landscape characterized by strategic acquisitions, regulatory successes, and scientific advancements aimed at addressing complex diseases with innovative therapies. As these sectors continue to evolve, stakeholders must navigate a complex interplay of technological advancements, regulatory scrutiny, and competitive pressures to drive meaningful advancements in healthcare outcomes. Stay tuned with Pharma Daily as we continue to explore these significant shifts shaping the future of healthcare and drug development. Thank you for joining us today as we unpack these pivotal stories impacting our industry.Support the show

In this episode of the UConn Internal Medicine Podcast Series, we discuss the evolving role of biologic therapies in asthma and COPD. We review how biologics target Type 2 inflammation, how to identify patients with severe asthma who may benefit from therapy, and how biomarkers such as blood eosinophils, FeNO, IgE, and allergic sensitization guide treatment selection.We also explore newly approved biologics for COPD, practical differences between available agents, expected benefits, steroid-sparing effects, safety considerations, pregnancy counseling, helminth screening, and real-world barriers such as cost and insurance approval.This episode is designed for internal medicine trainees and clinicians looking for a practical framework to understand when to consider biologics, how to choose the right agent, and what to monitor after starting therapy.Hosts:Dr. Hossam Albeyoumi Mohammed, and Dr. Simran Umra, Chief Medicine Residents, UConn.Dr. Alisa Pasichnik, and Dr. Caroline McCauley, 3rd year medicine residents, UConn.Guests:Dr. Ethan Bernstein, Associate Program Director of the Department of Pulmonary and Critical Care Medicine, UConn.Dr. Angela Quental, incoming Assistant Professor in the Department of Pulmonary and Critical care medicine, UConn.Edited by:Dr. Hossam Albeyoumi Mohammed, Chief Medicine Resident, UConn.Music:LoFi Girl by Snoozy Beats | Free Music Archive | Livense: CC BY.

TR is an 88-year-old man who is disabled and in chronic pain from spinal stenosis and knee osteoarthritis. He has multiple other medical issues, including coronary artery disease and COPD.He has been through years of treatment for his knees and back, including physical therapy, multiple joint injections, and an in-office procedure for spinal stenosis. He has been on multiple regimens of oral pain medications. He is not interested in surgery (and probably would not be considered a reasonable candidate if he were).He comes to a visit and asks what can be done.Sensible Medicine is a reader-supported Substack. If you appreciate our work, consider becoming a free or paid subscriber.We are taught never to say, “There is nothing I can do for you.” We may be out of surgical or medical options, but we can always continue to care for and support our patients. This is not part of the Hippocratic Oath, but it is so integral to our training that one might think it belongs there.There are good reasons to caution doctors from saying some version of, “I am sorry, I don't think there is anything more I can do for you.” It is true that in 21st-century medicine, the act of caring for patients has been so trivialized that we need to remind ourselves that caring is not just a last resort but our first responsibility.Hope in the face of illness is exceedingly valuable. Robbing this hope is not only cruel, but probably bad for the health of patients.Then there is the truth that when one doctor has nothing left to offer, medicine often still has more to offer. I am still haunted by at least one case when I mistook my lack of knowledge for a shortcoming in the field.A doctor saying he has nothing left to offer may be taking the easy way out. Further research or a considered referral often suggests effective treatments, if not cures. There is always a risk that when we say, “We can't help,” we are wrong.All this being true, I don't think we admit that there is nothing left to be done often enough. The Modern Hippocratic Oath does include the line:I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.Is it that much of a stretch to imagine the oath saying:I will not be ashamed to say “I have nothing left to offer beyond my ongoing care and commitment”, nor will I call in my colleagues, knowing they have nothing to offer beyond protecting me from admitting medicine's limitations.We no longer conceal bad diagnoses from patients; we consider this unethical. It is time that we consider it unethical to conceal that we have nothing to offer beyond palliation.It is hard to tell patients that the best we can do is control pain, especially when we have been trained not to. It takes work to be sure that neither you nor your colleagues have something to offer beyond a hamster wheel of care to provide hope but nothing more. It also takes some guts; we can never be 100% sure that nobody has anything to offer.Yet there are downsides to never saying we are done. Many patients accept that further care is futile, not after an honest conversation, but after being worn down by my endless visits, treatments, and promises that lead nowhere. All the while, time and money are wasted; time and money that could be better spent on life. The useless medical care leaves patients and their families increasingly frustrated by a medical system that refuses to be honest and caring.There are patients who welcome an honest assessment of their options and shift their focus to living with their disease and disability. There are also patients who do not. I've had patients fire me for saying there was nothing to do. They left me to get on that hamster wheel of care. This decision did not make them better, but maybe it made them happier and more ready to accept the inevitable. Eventually.TR calls now and then and comes to see me every three or four months. He tells me about his symptoms and the things he wishes he could do. I tell him there are things he could try and people he could see, but I let him know I don't think any of these options would be productive. He tells me he's not interested. I advise him to push up on his pain medications and to pretreat his symptoms; I know he will not take this advice. I know we will repeat this visit in the future; I actually hope we will, for years. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

On today's episode of Beating Cancer Daily, Saranne welcomes Jacqui Bryan, a functional medicine expert, to explore the often-overlooked challenge of muscle loss and its impact on individuals facing cancer, aging, and chronic illness. The conversation centers on sarcopenia, or age-related muscle decline, highlighting not only its insidious onset but also practical strategies for prevention and reversal at any age. As a 33-year Stage IV cancer survivor, Saranne discusses her personal experiences with muscle and bone loss during treatment, while Jacqui shares actionable advice for maintaining muscle health, even for those who are bedridden or recovering from cancer therapy. Jacqui Bryan is a certified nutrition specialist, whole health educator, health coach, and registered nurse. Having survived cancer herself, Jacqui brings firsthand experience and clinical expertise to her holistic approach. Her deep understanding of nutrition, movement, and the specific needs of cancer patients has helped countless individuals regain strength and reclaim their vitality."Sarcopenia is the slow erosion of your body's engine... It's almost entirely preventable and partially reversible at any age." ~Jacqui Bryan Today on Beating Cancer Daily:·     Sarcopenia, or age-related muscle loss, is a serious yet often underdiagnosed condition that can be both prevented and partially reversed at any age.·     Cancer patients, survivors, and anyone age 30 or older, especially those who are sedentary, are at increased risk of significant muscle loss.·     Muscle tissue is a metabolic organ crucial for blood sugar regulation, immune function, and maintaining independence as we age.·     Resistance training two to four times per week is the most effective strategy for preserving and building muscle, even well into your 80s and 90s.·     Adequate, high-quality protein (around 25-30 grams per meal) and nutrients such as vitamin D and omega-3 fatty acids are essential for maintaining muscle mass.·     Postmenopausal women and individuals with chronic conditions such as diabetes, heart failure, COPD, and chronic kidney disease face accelerated risks and should be especially vigilant.·     Chronic stress, poor sleep, and restrictive diets can all accelerate muscle loss; stress management and sleep hygiene are critical components of muscle preservation.·     For those struggling with muscle loss after treatments, especially Stage IV cancer survivors and the bedridden, asking healthcare providers about physical therapy and working with dietitians can make a significant difference. Contact Jacqui:jacquibryan.com 2025 People's Choice Podcast Awards Best Health Series FinalistRanked the Top 5 Best Cancer Podcasts by CancerCare News in 2024 & 2025,and #1 Rated Cancer Survivor Podcast by FeedSpot in 2024 to 2025. Beating Cancer Daily is listened to in 148 countries across 7 continents and features over 420+ original daily episodes hosted by Stage IV survivor Saranne Rothberg. To learn more about Host Saranne Rothberg and The ComedyCures Foundation:https://www.comedycures.org/ To write to Saranne or a guest:https://www.comedycures.org/contact-8 To record a message to Saranne or a guest:https://www.speakpipe.com/BCD_Comments_SuggestionsTo sign up for the free Health Builder Series live on Zoom with Saranne and Jacqui, go to The ComedyCures Foundation's homepage:https://www.comedycures.org/Please support the creation of more original episodes of Beating Cancer Daily and other free ComedyCures Foundation programs with a tax-deductible contribution:http://bit.ly/ComedyCuresDonate THANK YOU! Please tell a friend whom we may help, and please support us with a beautiful review. Have a blessed day! Saranne

In this week's Real Take, Tara Rafter reflects on her mother's final days living with COPD​ and the heartbreak of saying goodbye to the woman who had been her anchor throughout life.​If this excerpt resonates with you, I highly recommend listening to the full episode:Tara Rafter: Hypervigilance to Healing​Growing up in a home impacted by alcoholism and domestic violence, she learned from a young age how to navigate uncertainty. Despite the difficulties her family faced, she speaks with remarkable compassion about both of her parents, who died far too young.A​nd alongside her personal story, Tara brings the perspective of a Master Neuro Linguistic Programming Practitioner and Executive Coach.Listen to the full episode wherever you get your podcasts. Hosted on Acast. See acast.com/privacy for more information.

​Topics covered include:​ Alcoholism​, domestic violence​, hypervigilance​, compassion​, motherhood​, self-abandonment​, being a carer​, death and loss​, grief​, faith​, spirituality​, forgiveness​, love​, safety​, self-worth​, self-sabotage​, overwhelm​, healing​.This week I'm joined by Master Neuro Linguistic Programming Practitioner, Executive Coach and founder of The Navigation Coach, Tara Rafter.Tara lives in Mayo with her husband Kevin and their son Kai.In this deeply honest conversation, Tara shares the story of her childhood growing up in a home impacted by alcoholism and domestic violence. She speaks candidly about the hypervigilance she developed from a young age, the lasting impact those experiences had on her life, and the remarkable compassion she holds for her father despite the challenges her family faced.Tara's story is one of resilience, but also of love, forgiveness and understanding. She reflects on her relationship with both of her parents, who died far too young. Her father passed away at the age of 58, while her beloved mother​, who was her anchor throughout life​, lived with COPD for several years before she died.We also explore motherhood, self-abandonment, self-worth, self-sabotage, overwhelm​ and what it means to truly feel safe in yourself.Alongside the more difficult chapters, this conversation is full of warmth and humour. Tara talks about her love of music​ and heading off to gigs on her own, her deep faith and the practices that have helped her navigate life's challenges.You can connect with Tara here:Website: thenavigationcoach.comEmail: tara@thenavigationcoach.com Hosted on Acast. See acast.com/privacy for more information.

Matthew "Oki" O'Connor is the CEO of Scientific Affairs at Cyclarity Therapeutics, a clinical-stage biotech building a new class of medicines designed not to slow the accumulation of vascular damage but to reverse it. Oki and Chris first crossed paths as postdocs at Lawrence Berkeley National Lab in the mid-2000s — Oki was in Irina Conboy's lab, not far from the late Judy Campisi's group, where Chris was then working on cellular senescence. After Berkeley, Oki spent nearly a decade running the research program at the SENS Research Foundation, the organization most identified with the "damage repair" framing of aging biology, before co-founding Cyclarity (then known as Underdog Pharmaceuticals) in 2019 to translate one of SENS's most drug-tractable ideas into an actual molecule.When Oki was last on the show in March of 2023 (Episode 36), Cyclarity was deep in IND-enabling work and its lead asset, UDP-003, had only ever seen the inside of a mouse artery. At the end of that conversation, Chris asked what Oki hoped to be discussing the next time he visited. He answered, bluntly, that he wanted to be presenting human data. Last month, at the AHA Vascular Discovery Sessions, Cyclarity reported the results of their first-in-human Phase 1 trial of UDP-003 — a designed cyclodextrin that selectively binds 7-ketocholesterol, the oxidized cholesterol species that drives foam cell formation and arterial plaque. He's back to discuss what the drug actually did when it went hunting for 7KC inside a living human being.In this episode, Chris and Oki cover the unmet need that lipid-lowering drugs — statins, PCSK9 inhibitors, the coming Lp(a) agents — still don't address: none of them remove the damage already sitting in an artery wall. Oki explains the basic chemistry of 7-ketocholesterol and why macrophages, lacking the machinery to recycle it, collapse into foam cells and seed the necrotic core of advanced plaque. They walk through the engineering of UDP-003 as a dimeric beta-cyclodextrin "double cone" tuned for a single oxidized cholesterol species, the design of the 72-volunteer Australian Phase 1, and the exploratory pharmacodynamic readout that has the field's attention: dose-dependent urinary excretion of 7KC, stoichiometric with drug, cleared within a day. The conversation then turns to the 150-patient Phase 2 plan in coronary artery disease patients with plaque imaging as the primary biological readout, the funding math that stands between Cyclarity and that trial, the platform's reach into NASH, vascular dementia, AMD, and aging itself, and how all of this descends from the SENS damage-repair philosophy that Oki has been carrying since LBL.The Finer Details:- Why current standard of care is not enough — statins, PCSK9 inhibitors, GLP-1s, and the soon-to-arrive Lp(a) lowering agents all act by slowing the accumulation of arterial damage, not by reversing what's already there; despite 30 years on the market, statins have never demonstrated an all-cause mortality benefit in a clinical trial, and even the best statin imaging data shows only 1–2% plaque volume regression at very high doses in a subset of patients- The scale of the problem — atherosclerosis is estimated to contribute to roughly 40% of all human deaths once heart attack, stroke, and a surprisingly large COPD contribution are risk-adjusted in, on top of an enormous morbidity tail that includes angina, peripheral artery disease (up to and including amputation), and a growing case for vascular dementia as an undercounted driver of cognitive decline- The biology of 7-ketocholesterol — when an oxygen free radical reacts with cholesterol, it preferentially attacks the 7 position, and a second oxidation step locks the molecule into 7KC, a stable toxic species cells were essentially never equipped to recycle; it builds up in long-lived cells like macrophages, eventually shutting down their ability to traffic lipids back to the liver via HDL and converting them into foam cells that seed soft plaque and, over years, the necrotic core of advanced lesions- The molecular design of UDP-003 — cyclodextrins are naturally occurring carbohydrate rings; the beta size fits half a cholesterol molecule, and Cyclarity's in silico work showed that two beta-cyclodextrins facing wide-side to wide-side form a "double cone" that can fully encapsulate a single cholesterol; engineered correctly, that wrapper can be made selective for 7KC over native membrane cholesterol, which is what gives the drug its therapeutic window- The Phase 1 trial design and result — a traditional 72-volunteer safety study in Australia, split between single ascending dose and multiple ascending dose arms, escalating up to six doses at what Cyclarity believes will be the efficacious level; no serious adverse events, no bioaccumulation, drug excreted essentially completely in the urine (as predicted preclinically), and — the headline exploratory endpoint — dose-dependent urinary 7-ketocholesterol appearing on the same timescale as the drug, consistent with one molecule of UDP-003 binding one molecule of 7KC and leaving the body together- What the urinary 7KC readout can and cannot tell you — the easiest 7KC to mobilize is the free pool in circulation, but there is not nearly enough of it floating in the bloodstream to account for what came out in urine, which means the drug is reaching deeper compartments; how much is coming from vessel wall plaque versus liver versus other peripheral tissues will require the imaging endpoints of Phase 2 to answer- The Phase 2 plan — 150 coronary artery disease patients (the coronary being, as Oki puts it, the artery most likely to kill you), with baseline plaque imaging, a year of dosing, and a repeat scan; safety and PK continue, inflammatory biomarkers come on, and plaque volume change is the prize — for context, a 1% change in plaque volume is associated with roughly a 20% change in next-year risk of heart attack or stroke- The funding math and the platform — Cyclarity has raised $33M to date and needs roughly $45M more to run the Phase 2, with Phase 3 cardiovascular outcomes trials running into the hundreds of millions and likely requiring a pharma partner; beyond atherosclerosis, 7KC is elevated in NASH livers, in Alzheimer's brains, and in the retinal cells that die in age-related macular degeneration, and the underlying chemistry — designed binders that drag a specific toxic molecule out of the body — is meant to generalize into a pipeline against other accumulated damage species, the direct intellectual descendant of the SENS damage-repair programQuotes:"Atherosclerosis, or the plaque that builds up in your blood vessels in your arteries, is estimated to cause approximately 40% of all human death.""When [the macrophage] eats up too much oxidized cholesterol, it just accumulates it… And that's when you get this transition to these kind of monster blob cells called foam cells.""One molecule of our drug is supposed to bind one molecule of 7-ketocholesterol and then go away and never be seen again. You excrete both of them together.""A 1% change in plaque volume is associated with a 20% risk in the next year of your probability of having a heart attack or a stroke.""You pick one target at a time, you do it well, and you take it all the way to the clinic and hopefully prove that you can actually cure patients, help them get better, help their plaque shrink away, and prove that this approach can work."Links:Cyclarity Therapeutics: https://cyclarity.com

Welcome to the Atomic Anesthesia podcast hosted by CRNA professor Dr. Rhea Temmermand and Co-Founder Sachi Lord. On this show, you'll hear clear, clinically grounded discussions designed for nurse anesthesia residents and CRNAs who want to feel more confident in complex pharmacology, physiology, and real-world anesthesia decision-making.Want more content like this? Become a member of our learning platform: http://atomicanesthesia.comIn this episode:Why COPD is more than a lung problem — how alveolar destruction, V/Q mismatch, and cor pulmonale connect at the bedsideHow to ventilate a COPD patient intraoperatively: I:E ratios, PEEP strategy, and avoiding auto-PEEPThe pharmacology of bronchodilators — LABAs, LAMAs, and inhaled corticosteroids — and which ones to continue on the day of surgeryAnesthetic agent selection for reactive airways: why volatile agents help, why nitrous oxide doesn't, and when to consider TIVAPostoperative priorities: extubation to NIV, oxygen titration in CO2 retainers, and preventing reintubation

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/EQG865. CME/MOC/AAPA credit will be available until June 17, 2027.Turning Down the Inflammatory Signal in COPD: Advancing Care With Biologic Therapies Targeting Upstream Cytokines In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Genentech, a member of the Roche Group.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/EQG865. CME/MOC/AAPA credit will be available until June 17, 2027.Turning Down the Inflammatory Signal in COPD: Advancing Care With Biologic Therapies Targeting Upstream Cytokines In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Genentech, a member of the Roche Group.Disclosure information is available at the beginning of the video presentation.

Christina Prevett shares a detailed case study of a COPD patient named Bob, demonstrating how HIIT training can improve functional capacity and oxygen efficiency in pulmonary rehabilitation. The discussion covers personalized exercise protocols, monitoring strategies, and the importance of adaptable training for chronic conditions.  

What does it take to go from helping millions of people breathe easier to helping patients keep their legs?   Join The Heart of Innovation as Kym McNicholas talks with Sarvajna Dwivedi, Ph.D., entrepreneur, inventor, and CEO of AngioSafe, whose career has spanned some of the most challenging problems in medicine.   Sarvajna co-founded Pearl Therapeutics, a company focused on breakthrough respiratory therapies that was ultimately acquired by AstraZeneca for $1.15 billion. Along the way, he helped develop inhaled therapies and drug-device combinations designed to improve the lives of patients with asthma and COPD. (AngioSafe United States)   Today, his focus has shifted from the lungs to the arteries.   As CEO and co-founder of AngioSafe, Sarvajna is leading the development of the Santreva-ATK Endovascular Revascularization Catheter, a novel device designed to restore blood flow through some of the most challenging chronic total occlusions (CTOs) physicians encounter in patients with peripheral artery disease (PAD). The technology is designed to cross completely blocked arteries, compress plaque, create a new channel, and restore blood flow without relying on a guidewire or external power source. (Medical Economics)   In this episode, we discuss:   • How a pharmaceutical scientist became a medical device innovator   • The story behind Pearl Therapeutics and its $1.15 billion acquisition   • Why chronic total occlusions remain one of the biggest challenges in PAD treatment   • How AngioSafe's Santreva-ATK technology works   • What it means to restore blood flow through arteries that are 100% blocked   • The future of cardiovascular and vascular innovation   If you or someone you love has peripheral artery disease, diabetes, leg pain while walking, non-healing wounds, or has been told an artery is completely blocked, this is a conversation you won't want to miss.  

Before watching the video, can you guess which conditions vitamin D has actually been proven to work for in randomized, double-blind, placebo-controlled trials?

Dr. Daphne Bascom earned a DPhil/PhD in physiological sciences at the University of Oxford, a medical degree at the University of Pittsburgh, and completed fellowship training in microvascular and reconstructive surgery of the head and neck at Oregon Health Sciences University. She has more than two decades of executive leadership across health systems, health technology, and community health. Most recently, she served as Vice President of Population Health at Saint Luke’s Health System in Kansas City. So, how and why did she leave all of that to pursue lifestyle medicine, a “vegetable-forward” way of life, and a completely different kind of care? As we've heard from many of our guests, for Dr. Bascom, it was personal. Between witnessing her mother's long and arduous struggle with COPD and helping her father navigate the healthcare system, she recognized that despite her many years of training, her work as a surgeon, and her leadership, she still wasn't doing the work that got her into medicine in the first place. She wanted to help people be healthy. Period.  That deep calling led her to become the Chief Operating Officer of The Vegan Gym, a global digital health platform dedicated to plant-based performance, healthspan, and longevity. She now hosts the Thrive on Plants podcast and is the Founder of The Longevity Lab. As a lifelong believer in equity and inclusion, Dr. Bascom works hard to ensure that this information is accessible to all people, and much of the education she puts together on these topics is available for free on her YouTube channel, @TheVeganGym.

COPD can feel overwhelming when you are trying to memorize symptoms, diagnosis criteria, and treatment strategies all at once.      In this episode, Alex and I walk through a practical COPD review that covers the essentials you need to know for boards, including classic presentations, key differences between chronic bronchitis and emphysema, diagnostic spirometry cutoffs, and the GOLD treatment groups.                               Get full show notes, transcript, and more information here: https://blog.npreviews.com/COPD-review-for-boards              Follow us on Instagram: instagram.com/smnpreviewsofficial