Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
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.
Does your approach to extubating obese patients differ from your approach in non-obese patients?
If the patient has OSA/OHs I often extubate directly to CPAP OR bipap especially if they have high compliance to OSA cpap therapy and are "used to the mask". But if high levels of secretions, NIV can make clearance of secretions more difficult. Thus, individualize therapy is indicated.
When do you entertain a diagnosis of HLA-negative antibody mediated rejection in lung transplant recipients?
What therapies do you routinely use to prevent mucus plug formation after endobronchial stent placement?
After airway stent placement, especially silicone stents and/or Y stents, I start my patients on albuterol neb BID; hypertonic saline neb BID, and NAC neb BID. If there are any issues with adherence, I use either albuterol + hypertonic saline or albuterol + NAC depending on patient preference. If th...
Did the low rate of COPD exacerbations in the BOREAS cohort overall confound the results of the study?
I feel that the results are still very impressive despite this.
Are the results of the BOREAS trial generalizable to non-white populations?
There is currently not enough data to conclude that the trial is generalizable to non-white population.
Will you use FeNO testing in all COPD patients to determine whether they are candidates for therapy with dupilumab?
I suspect high eosinophils will be used more often.
How long do you normally wait before considering any bronchoscopic procedure (EBUS-TBNA, Transbronchial biopsy) after an episode of acute PE in a patient needing these procedures?
This depends upon the indication for bronchoscopy and the risk stratification for an acute PE. Generally, anticoagulation can be stopped safely for a short period of time after 10 to 14 days of therapeutic coagulation in low-risk PE but for higher-risk patients or if the bronchoscopy is not urgent a...