#500: COPD Update with Cyrus Askin

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 6 October 2025

⏱️ 82 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

GOLD Updates, Novel Treatments, and Managing Comorbidities in COPD Care

Level up your COPD care with practical, evidence-based strategies. Learn how to confirm airflow obstruction with spirometry (and use LLN/Z-scores thoughtfully), stage patients with the A/B/E framework, and build treatment around long-acting bronchodilation—adding ICS selectively based on exacerbations and eosinophils. We’ll highlight the nonpharmacologic moves that change outcomes (smoking cessation, vaccination, pulmonary rehab, oxygen when indicated), when to reach for add-ons (azithromycin, roflumilast), how to approach chronic hypercapnia with home NIV, and what’s new (hello, ensifentrine). Pulmonologist and longtime Curbsiders member Dr. Cyrus Askin (@Askins_Razor ) returns to share real-world pearls for diagnosing, treating, and managing comorbidities in COPD.

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Show Segments

Intro
Case 1
Diagnostic Workup
Understanding the Ratio, LLN/Z-Scores, and Equity
Symptom abd Risk Staging (A/B/E)
Case 2
Foundational Care
Initial Inhaler Strategy
Progression & Hypercapnia: NIV & Adherence Counseling
Add-On Pharmacologic Options for Frequent Exacerbators
What’s New and Emerging
Comorbidities and When to Refer
Take-Home Points Recap
Plugs, CME, and Credits

Credits

Written and produced by Paul Wurtz MD. Show notes, cover art, and infographic also created by Paul Wurtz MD.

Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Reviewer: Emi Okamoto MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Cyrus Askin MD

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Transcript

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0:00.0	Hey, before we get to the show, I wanted to remind you to check out our Patreon at patreon.com slash curbsiders.
0:06.7	If you haven't signed up yet, sign up now to get ad-free episodes, twice-monthly bonus episodes, and a whole bunch of other cool stuff at patreon.com slash curbsiders.
0:19.4	My dog Minton ate all my shuttle cocks.
0:26.5	Wait.
0:27.5	Oh, ow, oh, he's a bad Minton.
0:30.5	He's a bad Minton, yes.
0:34.2	I don't know why I'm proud of my soul.
0:35.8	But I liked it.
0:36.6	I liked it.
0:54.7	The curbsiders podcast is for entertainment, education, and information purposes only. And the topics discussed should not be used solely to diagnose, treat, cure, or prevent any diseases or conditions. For the more of the views and statements expressed on this podcast are solely those of the host and should not be interpreted to reflect official policy or position of any entity aside from possibly cash like a more hostile and affiliate outreach programs. If indeed, there are any.
0:55.4	In fact, there are none.
0:56.8	Pretty much, we aren't responsible if you screw up.
0:58.2	You should always do your own homework and let us know when we're wrong.
1:06.7	Welcome back to the curbsiders.
1:12.5	I'm Dr. Matthew Francoato here with my great friend friend and America's primary care physician on our 500th episode, Dr. Paul Nelson Williams. Hey, Paul. Hey, Matt. How are you? I'm good, Paul.
1:20.3	It's been 500 and it feels like it's barely been five. I have aged so much. I'm so tired. We're in our 10th year. 10th anniversaries coming up in early
1:33.2	2026, but Paul, we've done it. We have a real treat tonight because we're talking about
1:40.1	COPD. We've done, we're going to go over the latest guidelines and some of the latest recommendations and therapies in COPD. We've done, we're going to go over the latest guidelines and some of the latest
1:45.8	recommendations and therapies in COPD with a fantastic pulmonologist, Dr. Cyrus Askin, who
1:52.4	he has been a curbsider. We talk about it since he was a second year medical resident,
1:58.0	almost the whole time we did curbsiders. He kind of joined at the end of our
2:03.4	one and a half years, like at the end of our second year, I guess, in 2016. So, yeah, it was early.
	...

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