Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
Do you administer immunosuppression to patients with idiopathic NSIP who have normal lung function and mild to moderate respiratory symptoms?
I think it depends on whether or not it clinically seems that the idiopathic NSIP is driving the mild to moderate respiratory symptoms. If there are no other clear causes of the respiratory symptoms (pulmonary hypertension, cardiovascular disease, airways disease, etc.) and the HRCT imaging findings...
What is your approach to evaluation and diagnosis following a non-diagnostic MSLT in a patient with suspected narcolepsy type 2?
A non-diagnostic study is a good time to review technical considerations of the study a second time. Was everything performed correctly? Was the patient on any medications which may have confounded the testing? Ideally, this should be determined during the initial read of the study although we are a...
Do you consider tracheostomy for the management of continued hypercapnea despite compliance with PAP in patients with OHS and OSA?
I would try AVAPS such as trelegy machine first before considering Tracheotomy. In most circumstances with good compliance, it helps with the hypercapnic failure.
What are your top takeaways from CHEST 2024?
Many great presentations at CHEST 2024. I was impressed by the Rapid Fire sessions where the outcomes on the latest trials for Robotic Bronchoscopy were discussed. It’s very encouraging to see the needle move forward in lung cancer accuracy diagnosis. Also a great opportunity to network and meet wit...
Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?
I think this is a great question. @Dr. First Last et al (NCT01933724) have conducted a study to answer that question (conveniently called TAPIR). In their analysis that was presented 1 week ago at the International Vasculitis Workshop, they found that patients on low-dose prednisone along with other...
Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?
The duration of maintenance therapy in patients with AAV depends on many factors and should be individualized. Some factors that are associated with a higher risk of relapse include PR3 positivity, seroconversion from negative to positive, ENT disease, use of a tailored approach to RTX dosing, and u...
How do you risk stratify patients with different WHO groups of pulmonary hypertension prior to non-cardiac surgeries?
First, I would direct the audience to recent AHA guidelines on the perioperative management of PH in non-cardiac surgery. Rajagopal et al., PMID 36924225In general, the severity of pulmonary hypertension and relevant comorbidities are likely more important than the WHO group. In patients with CTEPH,...
What is your approach to de-escalation of asthma therapy if patients have remained clinically stable on triple inhaler therapy and a biologic agent?
Since the reason most folks need biologics is prednisone and considering the side effects, getting patients down to the lowest dose is beneficial.
How do you treat CTD-associated organizing pneumonia?
The approach to CTD-associated organizing pneumonia is similar to that of CTD-associated NSIP and involves treatment with glucocorticoids and steroid-sparing agents. The evidence for the choice of steroid-sparing agents is extrapolated from clinical trial and observational data from systemic scleros...
Do you use any drugs prophylactically to reduce the risk of radiation pneumonitis in lung SBRT?
I have not although there are varying levels of evidence to support each of these agents. I think it points to a broader failure as a field to develop radioprotective strategies that could enhance our therapeutic ratio. RTOG 0123 made an attempt at a prospective evaluation of captopril to reduce rad...