Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
Would you place an IVC filter in a patient with an acute intermediate risk PE and a proximal DVT who is on anticoagulation?
No. The only role for IVC filter use is in patients who can not tolerate anticoagulation (Marron et al., PMID 32795479).
Do you recommend transfer to an institution with a PE response team for a patient with an intermediate risk PE?
This is an interesting and difficult question. It depends on the case of a high intermediate-risk submassive PE that we have. Whenever there is a debate on the approach, a relative contraindication for certain forms of anticoagulation, different approaches on a catheter-directed intervention, or a ...
Is there any utility in using lytics for loculated malignant pleural effusion?
Yes. We frequently use tPA for loculated MPE or non-draining TPC clinically. There are many small studies on the subject with mixed results.
What is your approach towards management of symptomatic broncholithiasis?
The broncholithiasis location relative to the airway can be outside the airway which is called peribronchial, inside the airway which is called endobronchial, or extends from inside to outside the bronchial wall which is called transbronchial broncholithiasis. Surgery is indicated in peribranchial b...
What is your preferred steroid sparing agent in the treatment of Sjögren associated LIP?
There is unfortunately very limited data comparing the efficacy of various steroid-sparing agents for the treatment of connective tissue disease-related ILD, and no large prospective studies have specifically addressed the ideal approach for patients with underlying Sjogrens. Mycophenolate and azath...
Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?
I use only intermittent.
How do you approach the use of chronic azithromycin in patients with CF who may require therapy with IV tobramycin in the future?
This question has been somewhat analyzed in the TEACH study comparing coadministration of azithromycin and inhaled tobramycin. The authors found no difference in lung function but higher pseudomonas CFU reduction in patients treated with inhaled tobramycin alone. In the situation of IV tobramycin fo...
How do you manage GI side effects related to CFTR modulator therapy?
We have found that for most patients liver enzymes abnormalities are small and transient; however, for about 1% of patients there are severe elevations and these patients are much more difficult to manage, even after withdrawal, and tough to re-challenge; it is also not patients with severe liver di...
What is your approach to the management of a patient with idiopathic pneumonia syndrome following stem cell transplant who does not demonstrate clinical improvement with steroid therapy?
Continue with good supportive care including diuresis, lung protective ventilation strategies for intubated patients, and a thorough evaluation for infection as retrospective studies have shown a relatively high rate of infection even in cases where the infection was considered to be ruled out (Seo ...
Are there preferred home exercise programs for patients without access to pulmonary rehabilitation?
There is Pulmonary Rehab toolkit on the pulmonary fibrosis foundation website. I will generally show it to patients and have them bookmark it on their phones.