Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
What are your top takeaways from CHEST 2023?
There were so many great presentations: My top 3 were the following. Pulmonary Hypertension: Expert Didactics and DiscussionThe Pulmonary Hypertension: Expert Didactics and Discussion course was a half-day discussion on pulmonary hypertension evaluation and management. This was a master class that ...
How do you manage immunosuppressive medications in patients who develop a pneumonia?
For most bacterial pneumonia in transplant patients, I prefer to avoid changing immunosuppressives and simply administer appropriate antibiotic therapy. This approach is effective and minimizes the risk of triggering acute rejection. For viral etiologies, I will often reduce or hold cell cycle inhi...
Do you add fludrocortisone to hydrocortisone when starting stress dose steroids in a patient with septic shock?
In septic shock, vasoplegia is mostly believed to be related to widespread inflammation that giving hydrocortisone is supposed to address, and current guideline suggests hydrocortisone only is sufficient. However, it makes sense to add fludrocortisone since most of these patients present with undefi...
What is your approach to monitoring patients with cardiac sarcoid while tapering immunosuppression?
Monitoring of patients with cardiac sarcoidosis (CS) is critical to optimizing therapy and improving outcomes. Once a decision has been made to institute immunosuppressive therapy, it is important that the efficacy of therapy is demonstrated and that the duration of therapy is guided by the response...
What is your approach to the management of symptomatic Cystic Fibrosis carriers?
It depends on what symptomatic means. If they have symptoms of bronchiectasis, I treat them as bronchiectasis patients with airway clearance, antibiotics, hypertonic saline, etc. If they have one mutation, I will also make sure they get full gene sequence and also do sweat testing (if available nasa...
Would you restart sirolimus for a decline in lung function or pneumothoraces in a pregnant patient with LAM?
Sirolimus is classified as a Category C medication by the FDA, so I have not used sirolimus during pregnancy. A recent study suggested that sirolimus use during pregnancy may be associated with spontaneous abortions, but in those who successfully gave birth, it does not lead to visible malformations...
Do you consider skin involvement associated with tattoos to be a marker of disease activity and an indication to start treatment in a patient with sarcoidosis?
Some patients give a clear history of swelling/pain/itch of tattoos coincident with extra-cutaneous symptoms. Others report no relationship. The variability may be related to the age, number, and size of the tattoos and the pigments they contain. Tattoos that cause symptoms should certainly be treat...