By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“Ancient medicine had once had a name for this something present in the living body but missing from the corpse. Spiritus was the breath, the regular, rhythmic breathing of the live body that is so shockingly absent from the dead.”

-Dr. Victoria Sweet, Author and Medical Historian

October is National Lung Health Month, sponsored by the American Lung Association. Why October? Possibly to coincide with the prime season for influenza vaccination.
Here are few ways (besides flu vaccination) primary care clinicians can support our patient’s lungs.

1. Asthma Treatment: Use combination formoterol-corticosteroid inhalers (such as Symbicort or Dulera) instead of albuterol or levalbuterol for short-acting relief of mild to moderate asthma. International and national guidelines and a strong evidence base support this approach.
2. Asthma Misdiagnosis: Be on the lookout for the 10% of patients with a diagnosis of asthma who have other conditions. Order spirometry or pulmonary function tests if the diagnosis is unclear, especially if not responding as expected to usual asthma treatment.
3. COVID: About 20% of patients hospitalized with COVID develop long-term lung damage, causing dyspnea and decreased exercise tolerance. Prevent permanent lung damage caused by COVID by encouraging all eligible patients to be vaccinated, especially pregnant women and teens. Consider use of monoclonal antibodies to treat early COVID infection to prevent it from becoming severe.
4. COPD: Ensure that patients discharged from emergency departments and hospitals for COPD exacerbations receive prescriptions for tapering oral corticosteroids and combination bronchodilators (long acting beta agonists and long acting muscarinic agonists).
5. Action Plans: Ensure that patients with COPD and Asthma have action plans to allow them to self-manage exacerbations.
6. Pneumococcal Vaccination: When giving annual influenza vaccine, co-administer pneumococcal vaccine for those who have not been previously vaccinated. Who are eligible? Adults over age 65, those with immuno-compromising conditions, chronic CSF leak, and those with cochlear implants.
7. Smoking cessation: ask about smoking status, provide counselling to those using tobacco products, and prescribe smoking cessation medications when appropriate.

Although these are core primary care activities, we sometimes are distracted by other clinical issues that come up in our visits. Please pass this along to your clinicians to remind them to think about more than just flu vaccine, this month.