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If the goal of headache therapy for adolescent migraineurs is a pain-free adult life, here's a road map.

Pediatric and Adolescent Migraine: Update on Treatment Options 

The RSV Vaccine Population was Narrowed for Good Reason, says Robert Hopkins, Jr, MD, Medical Director of the NFID

Recommendations for adult vaccination against respiratory syncytial virus (RSV) have fluctuated since the first vaccine became available in 2023. Most recently, in early summer, the Advisory Committee on Immunization Practices (ACIP) to the US CDC "tightened the recommendations [around] the groups that are likely to get the greatest benefit" from the immunization, Robert Hopkins, Jr, MD, medical director of the National Foundation for Infectious Diseases, explained in an interview with 

In the short video above, Hopkins explains the shift in population emphasis by the ACIP between June 2023 and June 2024, with the recommendation for a single lifetime dose raised from all adults aged 60 years and older to all adults aged 75 years and older, with adults in the 60-to-74-year-old population eligible if they are 

ACIP recommendations for the most appropriate older population for the RSV vaccine has shifted and the NFID medical director explains why. 

Clinical Topics

This image of the posterior neck of a 26-year-old woman shows a warty type fungating  lesion about the size of a quarter. It had been present since birth. It had been excised and treated with electrodessication several times previously but had always recurred. She had acute and chronic anxiety and would pick at the lesion.

The lesion was elliptically excised under local anesthesia in the office.

This lesion on the posterior neck of a young woman was present since birth and recurred after electrodessication. Can you Dx? 

A Warty, Fungating Lesion 

2025 GOLD Report on COPD Addresses Cardiovascular Risk in New Section: MeiLan Han, MD, MS, Highlights Rationale  

"The idea is that when we treat COPD aggressively, we’re likely achieving broader benefits beyond improving lung function alone."

Cardiovascular disease (CVD) is estimated to account for between one-quarter and and one-third of of mortality among people living with chronic obstructive pulmonary disease (COPD), with the the proportion rising to approximately 40% among those with a CV history.

The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report added a new section on CV risk in COPD that highlights the role of disease exacerbations in increasing the risk of CV events as well as the mechanical impact of cardiac hyperinflation on pulmonary vessels, and particularly during exacerbations.

In a recent interview with Patient Care,® MeiLan K Han, MD, MS, professor of internal medicine and chief of the division of pulmonary and critical care medicine at the University of Michigan Health, in Ann Arbor, MI, provided detail on the new section and the rationale for the inclusion in the updated guideline. In the short video segment above, she also commented on the decision to remove a section on vaccination against COVID-19 from the 2025 report and to expand recommendations on recently approved vaccines, eg, against respiratory syncytial virus. 

The following transcript of the conversation has been lightly edited for clarity and style. 

Patient Care: Addressing comorbidities in people with COPD has become increasingly recognized as essential to improving quality of life and overall outcomes. Do the revised GOLD guidelines address this topic?

: Yes, there’s a new section on cardiopulmonary risk. The relationship between the heart and lungs has always been significant and always been complex, but now it’s receiving increasing attention. For instance, we know that the lungs’ mechanical proximity to the heart means hyperinflation in the lungs can impair cardiac filling. We also know that inflammation in one organ can trigger events in the other.

An interesting finding we've seen in recent triple inhaled therapy studies is that maximal therapy for COPD doesn’t just reduce pulmonary events, like exacerbations and hospitalizations—it may also lower the risk of certain cardiac events. We’ve known for a while that severe COPD exacerbations are associated with an increased risk of heart attacks and strokes.

So this new section is encouraging clinicians to think more holistically. The idea is that when we treat COPD aggressively, we’re likely achieving broader benefits beyond improving lung function alone.

Patient Care: The section on COPD and COVID-19 has been removed from this edition. However, recommendations for other vaccinations for adults with COPD have been added. Could you discuss these changes?

 While COVID-19 remains important, we felt that clinicians have grown more comfortable managing it over the past few years. Initially, there was a need for extensive guidance, but now that the pandemic has become more familiar territory, we shifted our focus to other key vaccinations for adults with COPD.

One of the newer vaccines is for RSV, approved in the U.S. for individuals aged 60 and over. That’s something to consider for our COPD patients. We also want to increase awareness of vaccines beyond the usual suspects like flu, pneumonia, and COVID. For example, shingles, though not traditionally thought of as respiratory-related, can lead to complications like pneumonia.

The goal is to remind clinicians of these additional vaccines and their importance in protecting patients with chronic respiratory conditions.

is professor of internal medicine and chief of the division of pulmonary and critical care medicine at the University of Michigan Health, in Ann Arbor, MI. Han's research focus is on defining phenotypes in COPD using imaging. She is a lead investigator for several NIH sponsored COPD studies and serves as a spokesperson for the American Lung Association and board member of the COPD Foundation. She is currently a deputy editor for the

 American Journal of Respiratory and Critical Care Medicine 

and serves as a member of the GOLD scientific committee, responsible for developing the internationally recognized consensus statement on COPD diagnosis and management.

Cardiovascular comorbidities in adults with COPD are linked to poor outcomes including reduced QoL, increased hospitalizations, and greater risk of mortality, Han explains. 

"Vaccine-hesitant people are a broad group of folks, many of whom have had vaccines themselves but then have heard something that's just made them nervous, and need a chance to talk about those questions and concerns."

Gretchen LaSalle, MD, made this observation in an interview with Patient Care

 while discussing "the state" of vaccine hesitancy in the US right now. She points out that vaccine hesitancy is certainly not a new phenomenon, born of the COVID-19 pandemic, and that in her practice as a family physician she has seen an increase in immunization reluctance over time. 

But the pandemic has altered the tone of vaccine hesitancy, she says. 

In the following interview, LaSalle, a family medicine speicalist and author of the recent book 

Vaccine hesitancy didn't begin with COVID but family physician Gretchen LaSalle, MD, says the pandemic has changed the tone of the reluctance. She explains in this interview. 

Vaccine Hesitancy: How COVID-19 Changed the Tone, with Gretchen LaSalle, MD

Dariush Saghafi, MD

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