ATS Breathe Easy - Biologics: A Breakthrough Treatment for Asthma
You're listening to the ATS breathe easy podcast brought to you by the American Thoracic Society.
Speaker 2:Hello, and welcome. You're listening to ATS Breathe Easy with me, your host, doctor Amy Attaway. Each Tuesday of every month, the ATS will welcome guests who will share the latest in pulmonary critical care and sleep medicine. Whether you're a patient, patient advocate, or health care professional, the ATS Breathe Easy podcast is here for you. Joining me today are two people who have strong ties to the American Thoracic Society, doctor Monica Craft and doctor Didi Gardner.
Speaker 2:Doctor Craft is a former president of the American Thoracic Society and the Marie m Rosenberg professor and system chair, department of medicine at the Icahn School of Medicine at Mount Sinai. Doctor Gardner is chief research officer of the Asthma and Allergy Network and a member of the Public Advisory Roundtable, which integrates the patient perspective into ATS programs and activities like today's podcasts. Welcome to you both. So for this episode, we wanted to focus on an issue that a lot of clinicians deal with, which is dealing with asthma and then biologics in the context of treating asthma. Doctor Monica Craft is an expert on many things, and we are so fortunate that she's going to spend her time and expertise discussing this, podcast, which is going to be on asthma and biologics.
Speaker 2:So doctor Kraft, again, we are so excited to have your expertise today. And I think one of the things we wanted to start with was maybe you could talk about what is a biologic.
Speaker 1:Well, thank you. Thank you so much, Amy, for and the ATS for having me today. It's exciting. You know I love the ATS. Special it's a special place in my heart.
Speaker 1:And so, of course, talking about asthma is another topic I I I know very well. And, you know, biologics have been a very exciting aspect to asthma care, so I'm really excited that we get to talk about them today. And and a biologic is really something that comes from a living thing, like a bacteria, a plant, a cell, and and it targets a certain receptor or pathway of inflammation. In this case, it's the lung. You might have heard of Humira for rheumatoid arthritis, entanercept.
Speaker 1:Those are biologics for other diseases. We happen to have six biologics to treat asthma because the the understanding of the immunology of of asthma has exploded over the last couple of decades, and that has allowed the development of these treatments that target these specific receptors on cells and pathways. And and and we can we have them in our armamentarium now to treat our patients with severe asthma. So I'm really happy about that.
Speaker 2:Yes. I would say, it has really revolutionized. Biologics have revolutionized how we treat asthma. And so I think, as you mentioned, there's six different ones. So we wanted to really get your perspective on what factors guide your selection of a specific biologic for a particular patient for their asthma.
Speaker 1:Sure. Absolutely. So I take care of patients with asthma across the spectrum as well as COPD and other limb diseases. But when it comes to severe asthma, I start thinking about a biologic when I'm seeing a patient who's already really maximized with inhaler therapy. So they're on very good inhalers, like an inhaled steroid, and a long acting beta agonist or a long acting albuterol.
Speaker 1:Usually, it's in one device, and they're using that and they're very adherent. They may be on a a a second inhaler, which is like a, like a t atroprium, something like that, that's a long acting muscarinic antagonist that's also a bronchodilator, or it could be a controller like montelukast, something else. So they're usually on at least three controllers. And you and, you know, I've had conversations with patients. They've been adherent.
Speaker 1:They know how to use these medications. And they're still having trouble with asthma, mainly asthma attacks, meaning attacks that result in very acute onset, shortness of breath, wheeze, cough that require emergency room visits, urgent care, sometimes hospitalizations, and, ultimately, oral or IV steroids. So those are those are really concerning events. And so when those when patients experience those and I would say, you know, twice a year for sure, but even once a year, in my opinion, is is not ideal. But twice a year, yes.
Speaker 1:And in some countries, it takes actually four times a year to qualify for a biologic. But in The US, we start thinking about it maybe once or twice a year. Then, that's one of the the the features. We also wanna make sure that, additional processes that are going on with them have been addressed that can actually add to medication burden and asthma, like allergic rhinitis. Are they taking care of their sinuses in terms of their if they have an allergic component to their asthma?
Speaker 1:Are they using nasal steroids? Things like that to really help with the rhinitis. Do they have heartburn, gastroesophageal reflux disease? We know that just having acid in the esophagus can trigger a nerve that causes the airways to constrict. So we definitely wanna take GERD or reflux off the table.
Speaker 1:So is that being treated appropriately? Do they need a gastrointestinal GI evaluation? Do they have obstructive sleep apnea? It's another process that can actually add medication burden by increasing vagal tone. That same nerve that causes airway constriction with heartburn can also be triggered in sleep apnea.
Speaker 1:And then the last issue is the upper airway. With all this rhinitis happening, sometimes the upper airway, it actually it functions abnormally and can cause wheezing and shortness of breath and symptoms that really aren't asthma. So you have to make sure that's not going on. And not to mention, you've ruled out other diagnoses. So you're sure that's the diagnosis.
Speaker 1:You've really maximized their treatment. You've addressed these comorbidities, and yet these patients are still having these asthma attacks. So at that point, I'd start thinking about a biologic. So you've got all you've got this patient in front of you with severe asthma, has all the characteristics I was letting you know about, And then we wanna figure out what kind of asthma they have because it's it's not a one size fits all. It's very heterogeneous, and there's certain kinds of asthma that respond well to biologics and some that don't.
Speaker 1:And the five of the six are really focused on this type two asthma associated with the eosinophil. So the eosinophil is a white cell that you can measure in the blood. It's in the lungs. It's in the sinuses that's associated with sometimes allergic inflammation, sometimes non allergic, but it's this type two inflammation. And with type two comes these certain proteins that these cells make.
Speaker 1:You might have heard of interleukin four, interleukin five, interleukin 13 are sort of our three favorites. So we look at the blood eosinophil count for sure. And if that's elevated really above about a 50, but certainly above 300, we really start taking notice. And then if possible, try to measure an, nitric oxide in the exhaled breath. We call that FeNO.
Speaker 1:That's also a measure of untreated type two inflammation. So if we see the eosinophils up and the FeNO up or at least one of them, we start thinking, k. This patient has type two inflammation that's persist despite maximal therapy. And then we start thinking that maybe there are we have biologics that really target these type two pathways, which is really gratifying to be able to offer that. And then the last piece I'll say is these are injectable medications, and they're very expensive.
Speaker 1:So we go through a whole prior authorization process, which we can talk some more detail about. Then it's also really shared decision making with the patient because nowadays, they're all for home use. So patients are injecting themselves after teaching. We teach them in the clinic. Now I have a few patients that are a little bit nervous about doing that, so they actually go to infusion centers to get their injections or they come to see us in the clinic.
Speaker 1:I'd say the majority are learn to inject themselves and feel comfortable with it. But that's a very new aspect to asthma treatment that we really hadn't really addressed. And I will say, at least, you know, a lot of patients embrace it. Some are a little nervous about it. So that also goes into the conversation about whether they're willing to do this.
Speaker 1:And so then we talk about how long they're gonna be on it, which is at least four to six months to make sure that it's it's working. It really takes that long to decide if a biologic is really benefiting a patient and if they're ready to take on that challenge. And so that's where we we sort of we stop with that. And then, and, Didi, I'd love to hear your thoughts from the patient perspective if I've missed anything, if there's anything more you wanna cover.
Speaker 3:Yeah. So just in regards to shared decision making, I think that it's important that patients have a idea of what that means. Many of our patients here with the allergy asthma network, we use that terminology. They think they know, but maybe they don't. And so it gives us an opportunity to provide maybe a role modeling or even a video to talk them through or even a handout that maybe they can answer some questions before they come to meet you.
Speaker 3:So then they're prepared for that, shared decision making process.
Speaker 1:Mhmm.
Speaker 3:And then they feel empowered to be a part of the process to then determine if biologics are the right answer for them and their treatment for their severe abs.
Speaker 2:And I think some of it, we we had discussed that, it has to do with, like, how often you can give the medication, what also how that works is conducive to their lifestyle. I think that's that was one of the things as well. Right?
Speaker 1:Right. Right. And the biologics, they're they're variable in terms of how often they need to be given depending on the biologic. There's one that we give, every two weeks. There's others that are four, and some that are and one that's every eight.
Speaker 1:And they're mostly the the sub q injection. There's one that's in IV form that we we tend to use less often. That does require an infusion center, and it's a weight based type of dosing. I have used it, especially for patients where there's, like, obesity is a factor and and wanna make sure and really dose ideally. I have used it in those cases, but the vast majority of the time, we're using the injectable.
Speaker 1:And so that has to be something very, you know, acceptable to the patient. Oftentimes, the the medication gets mailed to their home once they have a teaching session and are are interested in taking it at home, and then they take it themselves. And then but the duration or the frequency is actually really important because some people aren't as interested in every two weeks, but are willing to maybe try every eight weeks. And and now I'm happy to say there was a recent New England Journal paper suggesting we may have a inhibitor of interleukin five coming out that's every six months. So that's exciting to think about.
Speaker 1:You almost have to put that on your calendar to remember to take it.
Speaker 2:That is so exciting. Oh, go ahead, Didi.
Speaker 3:No. I was just gonna say that'll be better for patients who have a little bit of, needle phobia, if you will, because, just Right. Again, we've done a number of focus groups with patients when it comes to utilizing biologics. And so their perception sometimes are that, you know, there is a a fear of needle. But like you said, once we get through the education, then patients are willing to accept that.
Speaker 3:You may have mentioned of timing. And so I can say that there are some barriers for timing. We do recognize that some patients will alter how long they will go because of the fact that the cost you may have mentioned of is, definitely a barrier for many of our patients. And so we do we encourage them to stay with the with the recommended dosing schedule, but some patients actually will let us know. I actually form make this go a little bit longer because of the cost.
Speaker 2:That's interesting. And and actually, that was we were we were going to maybe talk about what are some of the common challenges or barriers, to starting biologics. So I think you've already described one of them. Doctor Kraft, are there any other any other thoughts on the common challenges you see or barriers in your patients?
Speaker 1:Absolutely. Well, I think it's more there's trepidation about how long do do like, I get asked a lot, how long do I have to be on this medication? The rest of my life? You know, what does that mean? So that's number one.
Speaker 1:And usually, we go for, like I said, four to six month trial to see how well it works. And then there are patients that have been on these for years. There's actually our data now suggesting you can go a little longer or there's some that you can actually taper off, and the patients do well. About maybe twenty to thirty percent of patients who've been very stable on biologics for a long period of time can come off and actually enter a period of what we might think about as remission, which is a word that I never thought I would hear in the asthma space. Now that leaves a a pretty large majority that have to go back, but at least some seem to have some some demonstration of remission.
Speaker 1:So that's really exciting. So there's there's that piece. There's also the whole process of getting a a biologic authorized through insurance. That can take several weeks. There can be large co pays.
Speaker 1:So some of the biologics offer assistance programs. And what I've run into recently and I have to say for a long time, there really wasn't a lot of issue around the finances because, you know, everything was was covered pretty well in The US. I've noticed now that there's a little bit of a chink in that armor. I'm noticing co pays a little higher. You know, insurances wanting me to go with one biologic versus the other with no regard to biomarkers, which is quite upsetting because I think we practice pretty good precision medicine and asthma as best we can.
Speaker 1:And to be told from a, carrier that I have to go with a certain biologic that I don't think the patient really would benefit from is concerning. So that's another issue. And, also, one another thing that can happen that can be a really good thing is sometimes patients feel good and they stop their underlying inhalers because they're feeling so good. Now that's I call that a victory. However, when you when it's time to renew that biologic, the carriers may not because they'll notice that the patient's not taking their inhaled steroid anymore or they've drastically reduced the frequency.
Speaker 1:And so while I consider that a victory from a clinical perspective, I'll have to ask the patient to restart their medicine and stay on it for a period of time in order to renew the biologic. And I find that obviously concerning. So we have work to do in that arena.
Speaker 3:Mhmm.
Speaker 2:So that's yeah. Insurance, I guess, is a common challenge or barrier when it comes to biologics. And I think that was, I think the the thought of transitioning someone from a on a biologic that maybe they're well maintained on, their asthma's well controlled, and the thought of transitioning is concerning, I guess. If, we we were like, we I guess, we wanted to know what your thoughts were on transitioning a patient, I guess, in a perfect world where maybe you you think that it's time like, one biologic might be more efficacious. Or what are your thoughts on that?
Speaker 1:You know, actually, I'm really happy to say there's been some great data lately on switching. And so, really, when we think we do see partial responses to these biologics. I I certainly have what I call my poster children, those patients who respond beautifully, and everybody's happy. I wish the world were like that all the time. So we have we have, you know, some who have these partial responses, so they may get a little bit better in terms of reducing their frequency of exacerbations.
Speaker 1:Maybe they have some some small benefits to lung function, but overall, not really getting where they need to be. They're still requiring prednisone, and they have a lot of symptoms. The quality of life isn't quite where they want it. So at that point, we might think about switching. And because these biologics each target a certain pathway, and in a perfect world, I'd love to use combinations to get more than one.
Speaker 1:You know, they're not a steroid, so that's a really benefit beneficial aspect. But there have been data sometimes going from one to another, changing the the biologic that targets one pathway to another can have benefit. And so that and there have been a couple of studies recently suggesting that maybe the switching doesn't happen as often. There were, a couple of very large studies done in, in Europe where, in fact, only about ten percent, would were switched from one, to another. And so I feel like there like, there's the the ISAR study I'll I'll I'll quote, which had about 2,000 patients, and about 200 of them only switched, two twenty two to be exact.
Speaker 1:And then there was the chronicle study, which had over 2,000 patients. About, a 62 were the only ones that switched from one biologic to another. And so these were felt to be that was a registry, the the, International Severe Aspirin Registry and the US chronicle study were kind of real world data. And so I'm concerned that that isn't happening as much if patients really aren't responding. Because the data suggests that oftentimes when you do, that there are some nice results in terms of reducing exacerbations, improving symptoms, and improving lung function.
Speaker 1:So I think it's important whenever patients do start biologics that they get you know, monitored. They check-in with their physician. I I like to see patients usually about a month or so after they start their biologic, and then I may see them again at four months. And then if they're doing well, I may go another three or four months just to make sure that first six to seven or eight months, I I see them quite a bit to make sure that they're responding.
Speaker 2:So it sounds like you you've had you kinda mentioned that some of the studies maybe switching isn't something that they do often, but it sounds like you've had some positive clinical scenarios where switching you've had a benefit and you might encourage switching.
Speaker 1:Absolutely. I think that we do see some partial responses. Not everyone responds a %. And so I try to see patients, you know, usually within a month of starting a new biologic and then at least one or two more times in the first six to eight months to make sure they're on track. Because if they're if they're having exacerbations on biologics, usually, I wait till after they've been on four months.
Speaker 1:So anything after four months, I sort of attribute it to be you know, to to suggesting that biologic isn't happening isn't working as well. And then, so I'll consider maybe a change. So I want patients to try them for at least four months. But sometimes it'll go a little longer if it's not really clear they're having a complete response. Sometimes I'll go six to twelve months and then and then make a decision.
Speaker 1:The data out there suggests that, patients do well when we change biologics because there may be more than one well, there probably is more than one inflammatory pathway really raising its head in asthma. We're only targeting the one with the biologic. And And I'd say in a perfect world, I'd love to use combinations, but, maybe someday. But for now, I'll have to switch from one to the other. And there are nice data suggesting a reduction in exacerbations, improvement in lung function, and I've seen it in my own practice.
Speaker 2:Yes. That was one of the questions we wanted to ask you about the combination, but I think we we also wanted to know from the patient perspective. So, Didi, do you think that switching biologics, is there some trepidation there, or what are your thoughts on that?
Speaker 3:So in regards to switching, biologics or even going from one to the other, I think that patients really if they understand the reasoning behind it, then they're they would be on board. Just kinda going back to barriers is what, you know, we've seen is that we have kind of like five buckets for the patients. We have a group of patients who are, have a great relationship with their healthcare provider. The staff works really well with the patients and make sure that they get the biologic, that all of the steps are are very, very clear as to what they need to do. We have another group of patients that maybe they have a great relationship with their health care provider, but the process to get to that biologic is very muddled.
Speaker 3:And so they don't know that this is coming from a specialty pharmacy. They don't realize that there's going to be a phone call from a biologic coordinator. They may have been told that, but because of life in general, they don't answer the phone or they're at work. And so they miss some very important milestones that then impact the timing of them receiving that biologic. And so then there can be some frustration that is taking place.
Speaker 3:And so I find that, you know, again, just that education, we talked about educating them about using the biologic, but we have to also educate our patients about what the process is going to look like and why it's important for them to follow that process so that when the time comes for them to receive that biologic at home, that they're getting that, you know, on time and within a timely manner. But, again, transitioning biologics, patients are are they want their asthma to be better. They have been living with this for a long time, and they are very frustrated when medications are not working. And so when we get to that point of using a biologic or switching from one to the other, it's magnificent that they can do that. And then being able to, again, understand the process.
Speaker 3:And I think doctor Krafft also talked about cost. So just, you know, if there is a an assistance program for patients is to make sure that they recognize what that's going to look like. Because there's a lot of homework in regards to the assistance programs too that many of us may not be aware of. And so patients need to recognize that when they are enrolling in these, that there there's homework for them to do. It's not just getting the assistance of paying for that.
Speaker 3:There's more homework for them to do afterwards.
Speaker 1:Right. That's really good advice. So today, I had an interesting I saw a patient who has very severe asthma, had stopped smoking, and unfortunately started up again. Had been on a biologic, had an exacerbation. So we with it.
Speaker 1:So he but he's been on this biologic a long time. So is it time to switch or really focus on the smoking cessation? And so we really had a long conversation about what it would take to quit smoking, but then we might consider switching the biologic after we see the effects of not smoking because I'd always had this concern that this particular biologic is something that he didn't really qualify for as well per biomarkers. He was already on it when I saw him for the first time, and I thought another one might be more appropriate for him. And so so it's it's an it was an interesting discussion that we had.
Speaker 1:So we decided that we're gonna focus. He really wants to quit smoking, so we're gonna put all our efforts there. He'll keep up the other biologic and then come see me, and then we can decide, you know, do we need to make that change? And then we'll go through the the process to do that. But explaining that piece about getting the call from the coordinator, it's a specialty pharmacy, I do think that's really good advice because there's so many pieces that happen outside the the office, you know, for where the visit was that, can really go well or not so well.
Speaker 1:So, I think you're absolutely right on that.
Speaker 2:Yeah. I think that kind of seeing where your patients are at. Right? So your patient wants to quit smoking. That's amazing.
Speaker 2:Right? So you really wanna encourage that and then keep keep in mind the context of how you treat them with their biologics. Mhmm. And then I think so our our we really wanted to ask you what your thoughts were a little bit more on con combination biologics, if you ever do it, or have some strategies.
Speaker 1:I do. You know, as I mentioned, I I love the concept of using combinations, and there actually are ways you can do it. So if your patient happens to have atopic dermatitis, there and severe asthma, there actually is a a biologic that's for both. So you might wanna start that one first. Then, and then depending on if they completely respond, say they don't completely respond, you have the option of starting another biologic for the asthma.
Speaker 1:So I have done that. The more common scenario because, you know, what's interesting is I don't tend to see as much like dermatitis with severe asthma. It's sort of interesting because I see an adult population, but chronic rhinosinusitis and nasal polyps, plenty of that. And so that tends to really present itself oftentimes in thirties and forties. And often in these days, we have biologics that target polyps.
Speaker 1:And, again, you'll get some benefit from the asthma. But if the asthma isn't completely controlled, then you have the option of of of thinking of a second biologic for the asthma. So I have come up with those scenarios, and that's the very legitimate, not trying to, you know, do anything crazy. And so it can be a really nice nice way of using combinations. Didi, I don't know what you think if patients have give you any feedback about that.
Speaker 3:Absolutely. We've had a number of patients who have had who have asthma and have eczema and patients that have been in studies specifically for their eczema, who've been placed on a biologic. And then lo and behold, they said, oh my gosh, my asthma is improved. Right. Well, you get a two for one in this place.
Speaker 3:You do. You do. Helping them understand that it can be beneficial for their breathing as well as for their skin. And again, I just think that it really takes a lot of, you know, education. We haven't really touched on studies, but we are we do encourage our patients that if that could be a health option or health care option for them in the event that they aren't able to afford the co pays or other arrangements for paying for their medication is that they could have an opportunity to participate in a study that may benefit them to receive those biologics
Speaker 1:too. Absolutely. And I'm glad you brought that up because, we do trials, and we I have a usually, I have a research coordinator with me in clinic thinking about those patients who may wanna do these trials. Sometimes they're biologic focused, sometimes they're not. I think my patients are pretty used to it now.
Speaker 1:They're used to being offered studies. And, you know, usually, they're they're quite willing depending on the trial and where they are with their asthma and if they feel like they wanna try something. And I really appreciate that because how are we going to learn, you know, about new approaches, you know, new new, interventions if we if we don't have those willing participants. So I'm really grateful for that.
Speaker 2:It sounds like such a wonderful clinic that you have. And so we're so happy that you're able to give us your expertise today and how maybe we can treat our patients better and learning from you today. So we were wondering if you think, any thoughts on future, things in the pipeline. I know you already mentioned the six month biologics, so that's exciting. Any other thoughts on where we're headed into the future?
Speaker 2:Yeah.
Speaker 1:You know, there are some really interesting things happening down the road. We have, in addition to this long acting IL five inhibitor, dapimocumab, that's also, that so that's that was just published as a phase three. So that's moving along. There's an interesting, phase three study going on where looking at a a TSLP inhibitor and an IL thirteen inhibitor called lunececumig. And, it's actually phase two, I should say.
Speaker 1:And what that is is it's a interesting nanobody backbone. This is an injectable medicine where you can put different inhibitors onto the same medic onto the same drug, if you will. So this one has two biologics on it. So TSLP is a mediator produced by those epithelial cells that line the the lung, and they're sort of the first item defense, if you will. And so it's it's suppressing TSLP, which can create a lot of this type two inflammation and also non type two for that matter.
Speaker 1:And then it also inhibits IL 13, which is a type two cytokine, so you get two for one in that one. There's also speaking of TSLP, there's an inhaled TSLP inhibitor that's now in in in studies as well. So that's looking very, interesting. And so we'll see where that takes us. There's also, emacitinib, which is an tyrosine kinase inhibitor affecting some of the mast cell functions.
Speaker 1:A mast cell is one of these inflammatory cells in the lung and the sinuses that can release a lot of mediators, especially like leukotrienes and other preformed cytokines that can cause this airway inflammation that we that, you know, results in shortness of breath, wheeze, and cough. And, and then IL interleukin 33, which is a cytokine that's also produced by that airway epithelium, that's been it was looked at asthma for a while, and then it moved to COPD. So there's some interesting trials in the phase three space looking at IL 33. It looks like it's coming back to asthma. So we'll see what what that does.
Speaker 1:So I think I I could go on and on. The the pipeline is quite rich, and so I'm I'm excited about the future for sure.
Speaker 2:Yeah. I'm really excited about the all the the asthma treatments, but then also the COPD. So I see a lot of patients with COPD, so I'm I'm super excited.
Speaker 1:Oh, definitely. It's nice to have options for COPD because that's really a big unmet need as well. You bet.
Speaker 2:Yes. There was a while where it just felt like there wasn't a lot coming down the pipeline, so we're so excited too. It sounds like, Didi, so patients are pretty pretty excited about the future of asthma. Is that what are your thoughts when they kind of thinking about the future of biologics?
Speaker 3:So I think patients are excited about the future, but we have to remember, you know, social determinants of health do impact the access to these medications. And then we've talked a little bit about research. So again, patients know what they are provided or if they go and do a doctor Google research, And Doctor. Google is not the answer. So we want to be the AAN wants to be the resource of all so that patients, when they're looking for information and many of our patients are going out on TikTok, right, where they're going out on other types of social media to find information about the future of asthma.
Speaker 3:So allergy asthma networks actually created a TikTok channel to be able to be a well known resource that is credible and having credible influencers like Doctor. Kraft or some others physicians and even patients who are using the science to share their information. We've also utilized podcasts to get information out about studies and about the future of asthma, severe asthma specifically. And even, just recently, we had a biologic podcast specific for patients. So we had a patient being interviewed with a health care provider.
Speaker 3:So I think patients are very excited, but just also just remembering that, you know, when we're thinking about where medications are going is making sure that we have access to all so that those social determinants of health actually don't impact who gets and who doesn't receive that medication.
Speaker 2:Yeah. That's a great point. I mean, we you know, there's all this exciting medications out there, but if we can't get them to our patients, or they're not able you know, we're we talked a lot a lot about barriers, insurance, all these issues. So that is the real world, unfortunately, that we live in. So, well, that was such an amazing talk, and we just wanna thank doctor Kraft and Didi again for this really this, learning so much about biologics today on the ATS Breathe Easy podcast.
Speaker 2:So we just wanna thank them again.
Speaker 1:Thank you. Thank you for having us. It's great to be here. We appreciate it.
Speaker 2:Thank you for joining us for today's ATS Breathe Easy episode. Please subscribe and share this episode with your friends and colleagues. If you haven't yet done so, register for the ATS International Conference in San Francisco this May. Go to conference.thoracic.org today. Members get a discount on conference registration, so become a member or renew your membership to take advantage of the savings.
Speaker 2:See you next time.