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RespiratoryRecon, 1712 Commercial Drive, Naples, FL (2026)

03/15/2026

From Guesswork to Measured Adherence

Respiratory non-adherence is quietly devastating. Effective adherence to respiratory medications can be as low as 22%, driving an estimated $300 billion in avoidable costs and up to half of asthma and COPD exacerbations.

In my latest newsletter below, I unpack what you identified in the poll—patient understanding, regimen complexity, cost, and how we talk about adherence—and layer in the science behind each barrier. I also attempt to show how smart inhalers and digital adherence tools are already boosting maintenance inhaler adherence by about 18% while reducing downstream utilization, offering a practical, lower-cost way to move from guessing to measured adherence in real clinics.

https://www.linkedin.com/posts/timothy-myers-6483b326_respiratoryhealth-healthtech-copd-activity-7434575824072130560-zCjz?utm_source=share&utm_medium=member_desktop&rcm=ACoAAAVl1tgB14WILR2jJHMmD9ESpgul7DFleDw

03/13/2026

Generic Fluticasone Propionate HFA Approved for Asthma

FDA approval of the first true generic fluticasone propionate HFA inhalation aerosol (equivalent to Flovent HFA) as a prophylactic maintenance treatment for asthma in adults and children ≥4 years, delivered as a 44 mcg per actuation metered-dose inhaler. This follows the controversial withdrawal of branded Flovent products about two years earlier, when GSK’s move to authorized generics and Diskus formulations created insurance barriers, forced regimen changes, and was linked to some children discontinuing inhaled steroids altogether.

The new AB-rated generic, manufactured by Glenmark Specialty SA, is expected to launch as early as this month, with the FDA framing it as an important step toward more affordable access for approximately 20 million adults and 4.6 million children with asthma in the U.S.

Efficacy is supported by earlier trial data showing improved FEV₁ & reduced asthma symptoms, with maintenance use associated with fewer asthma-related hospitalizations & ICU admissions. Safety, contraindications, & precautions mirror the original Flovent labeling. The product is contraindicated for primary treatment of acute asthma or status asthmaticus, reinforcing its role strictly as a controller, not a reliever.

Key take-home points: (1) FDA-approved generic Flovent HFA is now available, likely improving affordability and formulary access; (2) this may help reverse ICS discontinuation that followed the branded product’s withdrawal; (3) clinicians should reinforce correct positioning of this inhaler as daily maintenance, not rescue; and (4) usual inhaled steroid safety monitoring (mouth rinsing, infection vigilance, eye and bone health, and pediatric growth tracking) remains essential.

Source: Ingram I. “FDA Approves Generic Flovent Inhaler for Asthma.” MedPage Today, March 4, 2026.

03/12/2026

When Asthma Myths Go Unchallenged Clinicians Share the Blame

Many adults with asthma hold persistent misconceptions that directly undermine control, adherence, and outcomes, even when guideline-based therapies are prescribed. The article highlights how unchallenged beliefs about symptoms, medications, and prognosis drive avoidable morbidity and healthcare use. Clinicians are encouraged to treat these myths as modifiable risk factors, using structured, empathetic conversations to uncover and correct them.

Patients often underestimate the seriousness of asthma, normalize chronic symptoms, and rely on short-acting bronchodilators as “primary” therapy, which reinforces poor control and crisis-driven care. Fear of inhaled corticosteroids—especially around growth, dependency, and long-term harm—remains a major barrier to appropriate controller use, despite strong safety data at recommended doses. The article recommends using concrete, personalized examples (e.g., activity goals, nocturnal symptoms, recent exacerbations) to reframe asthma as a controllable chronic disease rather than an episodic, “attack-only” condition.

Key take-home points include:
* Actively elicit and name common asthma myths in routine visits; if you do not ask, you will not find them.
* Reposition inhaled corticosteroids as the foundation of effective asthma care, while clearly distinguishing them from systemic steroids in language patients understand.
* Replace rescue-only mindsets with a prevention narrative that links daily controller use to fewer symptoms, exacerbations, and restrictions in work, school, and exercise.
* Use brief, structured education and shared decision-making to align treatment plans with patient beliefs, capacities, and goals, then reinforce these messages at every contact.

Confront asthma myths to improve patient outcomes. Panda M. Healio Allergy/Asthma. Published January 21, 2026. Accessed March 4, 2026.

ASTHMA AWARENESS American Lung Association

03/12/2026

Pulmonary Rehabilitation Week (March 8–14) is a timely reminder that PR is high‑value, underused therapy for patients with chronic lung disease.

Clinical benefits
* Improves exercise capacity (e.g., 6MWD, peak work rate) and functional status.
*Reduces dyspnea and symptom burden even when FEV₁ remains unchanged.

Utilization and outcomes
* Decreases COPD hospital readmissions and healthcare utilization when initiated post‑exacerbation.
* Associated with better health-related quality of life and, in some cohorts, improved survival.

Patient-centered impact
* Enhances self‑management skills: action plans, pacing, breathing techniques, early exacerbation recognition.
* Addresses anxiety and depression, supporting adherence and sustained lifestyle change.

Why it matters for clinicians
* PR converts “nothing more we can do” into a concrete, guideline-supported intervention.
* A simple referral can help patients move from homebound and fearful to active, confident, and engaged in their care.

03/09/2026

Lungs Removed. Heart Beating. Artificial Lung Buys 48 Hours to Transplant.

A recent case report describes the first use of a flow‑adaptive total artificial lung (TAL) to bridge a patient from bilateral pneumonectomy to successful lung transplantation after refractory septic ARDS. A 33‑year‑old man with influenza B–associated ARDS developed necrotizing pneumonia, multidrug‑resistant Pseudomonas infection, bilateral empyemas, & recurrent cardiac arrests despite maximal antimicrobials, source control, and venoarterial ECMO, prompting salvage bilateral pneumonectomy to remove the infectious source.

Following lung removal, a novel extracorporeal TAL circuit was configured to replace both gas exchange and the pulmonary circulation’s capacitance function. System used dual‑lumen venous cannula, dual left atrial return, & flow‑adaptive shunt to autoregulate right‑sided output & prevent acute right ventricular distension. Within hours, hemodynamics normalized, vasopressors were discontinued by 12 hours, lactate fell from 8.2 to less than 1 mmol/L by 24 hours, & O2 delivery remained stable without systemic anticoagulation. After 48 hours of TAL support, patient underwent bilateral lung transplantation, was extubated on day 7, discharged at 8 weeks, and demonstrated excellent 24‑month graft and cardiac function with full functional independence.

Clinically relevant take‑home points include: TAL systems may provide a bridge to transplant in carefully selected ARDS patients with uncontrolled infection and cardiovascular collapse; bilateral pneumonectomy plus extracorporeal support can serve as aggressive source control when conventional management fails; maintaining physiologic hemodynamics—not just oxygenation—is crucial in extracorporeal rescue; and integrating advanced molecular profiling may help distinguish irreversible from recoverable ARDS earlier, refining transplant timing and candidacy.

Source: Bose P. Artificial lung keeps patient alive after lung removal. News‑Medical, Feb 5, 2026.

03/07/2026

Steroids in Pregnancy: New Data Show Inhalers May Boost Your Baby’s First Breaths

This article reports that inhaled corticosteroid (ICS) use during pregnancy in women with asthma is associated with less impaired lung function in their infants at 4 to 6 weeks of age.

Three key points:

* The cohort combined women with physician-diagnosed asthma from the Breathing for Life Trial and non-asthmatic pregnant women from the NEW1000 study, with infant lung function assessed during natural sleep using tidal breathing flow–volume loops and functional residual capacity measures.
* Among 186 infants with both tidal breathing and FRC data, those born to mothers with asthma who used ICS had less evidence of impaired lung mechanics than infants of mothers with asthma who did not use ICS, with several tidal breathing indices showing statistically significant differences favoring ICS exposure.
* Trend analyses that incorporated a reference group of infants born to mothers without asthma showed a graded pattern: greatest impairment in infants of mothers with asthma not using ICS, intermediate findings with maternal ICS use, and the least impairment in infants of mothers without asthma.

Clinical pearl
In pregnant patients with asthma, maintaining guideline-directed control with ICS may not only reduce maternal exacerbation risk but also attenuate the early-life lung function penalty often seen in offspring of women with asthma, without clear signal of harm in this analysis—supporting proactive conversations about adherence rather than stepping down therapy solely due to pregnancy.

Source: Stong C. Using ICS for Asthma in Pregnancy May Protect Infant Lung Function. Pulmonology Advisor, December 19, 2025.

03/06/2026

Reimbursing Failure: How a Broken Payment Model Strangles Outpatient Pulmonary Rehab

PR vs cardiac rehab reimbursement

Medicare pays far less for pulmonary rehab than for cardiac rehab, despite similar staffing, equipment, and intensity. Typical historical figures show PR sessions reimbursed around 45–60 dollars per hour (now about 58 dollars with new CPT codes 94625/94626), while cardiac rehab sessions have been reimbursed at more than twice that rate, around 160 dollars, locking in a structural parity gap that makes PR a financial loser on any hospital dashboard. When margins are this thin, administrators cap capacity, avoid off‑campus expansion, or close programs altogether, which directly limits where clinicians can even send patients.

Strategies to increase PR referrals

Because reimbursement suppresses program capacity, clinicians also need low‑friction referral pathways that make PR feel like standard of care rather than an optional extra. Evidence-backed strategies include:

* Embedding automatic PR referral prompts in discharge order sets and COPD clinic templates.
* Providing targeted clinician education plus performance feedback on PR referral rates, which has boosted referrals by 3–36% in multiple interventions.
* Using discharge “care bundles” that require a documented PR referral for every eligible COPD hospitalization, increasing referrals by over 50 percentage points in some hospitals.

Examples of successful programs
Systems that pair better funding or creative financing with streamlined referrals show what’s possible. A community‑based PR program using pooled funding from private partners achieved strong completion and outcome gains comparable to large academic centers, demonstrating that when programs are financially viable and easy to refer into, patients enroll, complete, and benefit.

03/05/2026

Ambulatory Care Is Packed…So Why Is Respiratory Therapy Still Missing?

Swipe through any busy outpatient pavilion and you’ll see primary care, cardiology, endocrinology, nursing, pharmacy, and behavioral health all embedded in the chronic disease game—yet respiratory therapy is still mostly stuck inside the hospital walls. This graphic captures the reality of the 1995–2005 “lost decade,” when ambulatory care exploded but RT never claimed a clear outpatient seat at the table.

For a profession built around COPD, asthma, and sleep-related breathing disorders, that missing silhouette is more than a design choice—it’s a warning label for what happens when economics, policy, and professional identity keep us tethered to acute care while the real chronic-care work moves across the parking lot.

If we want the next decade to look different, we have to rewrite the story: define our outpatient value, fight for billing lanes, train for chronic care, and step into clinics, rehabs, and remote-monitoring programs as essential partners, not invisible cost centers.

Read “The Lost Decade: How Respiratory Therapy Missed the Ambulatory Care Revolution (1995–2005)” to see what went wrong—and how RT can finally claim its place in ambulatory care.

http://tiny.cc/RTAmbul

03/03/2026

What If the Next Great Medical Drama Wasn't About the Doctors?

The Pitt has reminded us what we've been missing. Since premiering on HBO Max in January 2025, it has earned a 95% on Rotten Tomatoes, won the Emmy and Golden Globe for Best Drama, and drawn widespread praise from the medical community for its unflinching, authentic portrayal of healthcare workers. It proved that audiences are hungry for something real — not Grey's Anatomy romance, not House-style lone genius, but the honest, brutal, and deeply human work of keeping people alive.

The Pitt owns the ER. But there's an entire hospital beyond those trauma bay doors — and one of its most critical teams has never had a show of its own.

"Breathless" is a hypothetical medical drama built around hashtag : the clinicians managing ventilators at 3am, stabilizing ARDS patients in the ICU, troubleshooting circuit failures in the NICU, and fighting hospital consultants who want to stretch one therapist across three floors overnight. They are, as one character puts it, the people between a patient and their last breath — and television has never told their story.

What made The Pitt resonate wasn't just the medicine — it was the expansive compassion, the sympathy for both staff and patients, the sense that every choice genuinely mattered. "Breathless" aspires to that same standard, grounded in clinical accuracy and driven by the quiet, extraordinary heroism of a profession most people couldn't name — until the moment they need it most.

The conversation about which healthcare workers deserve the spotlight is just getting started.

https://www.linkedin.com/pulse/breathless-episode-1-second-wind-timothy-myers-qndff

03/01/2026

Smart Devices, New CPT Codes: Is Your RT Skill Set Ready for Remote Respiratory Care 2.0?

Respiratory therapists (RTs) are positioned to become strategic leaders in remote patient monitoring (RPM) programs as CMS expands CPT codes for physiologic monitoring in 2026. The updated code set—including 99445 for 2–15 days of physiologic data (e.g., pulse oximetry, respiratory flow rate) and 99470 for the first 10 minutes of interactive treatment time—creates billable space for RT-led, tech-enabled respiratory care.

Strategic clinical role

RTs can design and run protocolized monitoring pathways for COPD, asthma, interstitial lung disease, and post-acute respiratory patients, using devices that stream data (oximetry, respiratory rate/flow, adherence, symptoms) into RPM platforms. By leveraging 99453/99454 for set-up and device supply plus 99457/99458 for ongoing management, RTs can own longitudinal coaching, inhaler technique reinforcement, and early intervention on deteriorating trends.

Smart devices and data operations

CMS’s intent to blend technology, clinical oversight, and patient engagement, which aligns directly with RT expertise in interpreting physiologic signals and respiratory metrics and patterns. RTs can lead device selection, workflow integration, and alert thresholds for smart devices, connected wearables, and home respiratory monitors, ensuring that data streams translate into actionable care.

Program and value-based strategy

Because the new RPM codes support shorter monitoring windows and smaller time increments, RTs can architect flexible programs—short bursts around medication adherence, post-exacerbation discharge bundles, or ongoing high-risk COPD surveillance. This positions RTs as key contributors to value-based models by preventing admissions, supporting guideline-concordant therapy, and demonstrating measurable program ROI from respiratory-focused RPM.

02/28/2026

Why Medicare Advantage Keeps Dropping the Ball on Respiratory Care

Medicare Advantage plans often underdeliver on respiratory care, even though lung disease is one of the most expensive, life‑limiting conditions they manage.

Narrow coverage rules
Most plans simply mirror Medicare’s minimums for pulmonary rehabilitation—typically 36 sessions over 36 weeks, with extra visits only if clinicians fight for additional authorization. That might look generous on paper, but it rarely matches the long‑term, progressive nature of COPD and post‑COVID respiratory dysfunction.

Prior authorization barriers
Specialty services like pulmonary rehab, NIV, oxygen, and DME are routinely routed through prior authorization queues. For fragile patients, every extra form, denial, or appeal can mean weeks of delayed therapy, deconditioning, and preventable hospitalizations.

Undervaluing respiratory professionals
Payment and utilization rules tend to treat respiratory therapy as a commodity rather than a core chronic‑care discipline. Programs are pushed to “do more with less,” limiting individualized exercise prescription, education, and behavior change work that actually reduces readmissions and emergency visits.

Fragmented, short‑term thinking
Finally, Medicare Advantage products are structurally incented to focus on yearly costs, not decade‑long lung health. That short horizon undervalues early pulmonary rehab, proactive NIV, and structured COPD action plans that could keep people out of the ICU entirely.

If plans want to get respiratory care right, they must move beyond box‑checking coverage and start investing in continuous, team‑based breathing health.

02/27/2026

The Future of Pulmonary Rehabilitation

Pulmonary rehabilitation is one of the most evidence-based interventions we have for chronic respiratory disease—improving exercise capacity, quality of life, and reducing hospitalizations. Yet we're facing a crisis: less than 3% of patients who could benefit actually access these programs. Traditional center-based models are closing due to poor ROI, high overhead, and completion rates of just 20-30%.

But what if the solution isn't to save the old model, but to reimagine it entirely?
The digital age offers an unprecedented opportunity to transform pulmonary rehabilitation delivery. By combining wearable sensors for continuous monitoring, AI-driven exercise prescription, video-based training with technique feedback, and behavioral engagement strategies, we can create programs that are more accessible, personalized, and effective than traditional models.

The evidence is compelling: telerehabilitation shows non-inferiority to center-based programs for exercise capacity and quality of life outcomes, while achieving completion rates of 80-84%—nearly triple traditional programs. Remote monitoring has demonstrated 40-56% reductions in hospital admissions. Digital platforms eliminate travel barriers, reduce costs, and enable continuous data collection that can predict exacerbations days before symptoms appear.

This isn't about replacing clinicians with technology—it's about using technology to extend clinical reach and impact. The rehabilitation team remains central, but AI handles routine monitoring and progression while clinicians focus on complex decision-making and motivational support.

http://tiny.cc/NewPRehab

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Tuesday	9am - 5pm
Wednesday	9am - 5pm
Thursday	9am - 5pm
Friday	9am - 5pm