Pulmonology&nbsp;&nbsp;&nbsp;

Is dyspnea without radiation pneumonitis a side effect of lung radiation?

Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?

When attempting PEEP titration, how long do you wait after decrements or increments to assess for a change in driving pressure?

Do you prefer using end-expiratory or mean pulmonary artery wedge pressure obtained during diagnostic right heart catheterization for the classification of precapillary vs postcapillary PH?

What is your approach to steroid sparing therapy in patients with suspected CTD-ILD?

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?

Normally, waiting 6-12 weeks of therapeutic anticoagulation after an acute PE is suggested for any bronchoscopic procedure, however there is always a ...

What are your top takeaways from CHEST 2023?

What are best practices in management of severe acute infusion reaction from infliximab?

Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...

In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?

How does the presence of interstitial lung disease affect your decision to offer SBRT for early stage NSCLC?

Specifically in O2-dependent patients? Have any dose/fractionation regimens been shown to reduce the risk of pneumonitis in this population?

What is your approach to a patient who has a cardiac PET scan suggestive of sarcoid but no other supporting evidence of a diagnosis of sarcoid?

Do you typically push for myocardial biopsy in this case?

What patient factors prompt you to consider starting dupilumab in patients with COPD?

Does active smoking status influence this decision?

Did the low rate of COPD exacerbations in the BOREAS cohort overall confound the results of the study?

Are the results of the BOREAS trial generalizable to non-white populations?

The cohort in the study was predominantly white. Do these results highlight significant disparities in COPD care?

Will you use FeNO testing in all COPD patients to determine whether they are candidates for therapy with dupilumab?

If so, would this be a consideration in all patients regardless of active smoking status? FeNO in active smokers has been questioned, could this have ...

Would you give T-DXd to patients with resolved drug-induced ILD from other agents such as prior chemo/targeted therapy/immunotherapy?

What is your approach in differentiating IPAF (interstitial pneumonia with autoimmune features) versus "CTD ILD" in patients with serologic abnormalities but do not fulfill criteria for autoimmune disease?

How long do you continue surveillance with imaging and sputum cultures in a patient with NTM with no indications for treatment?

Have you seen rheumatoid nodules or RA-ILD in patients with seronegative RA?

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

What is the risk of ILD recurrence in MDA5/Ro52 positive dermatomyositis following a lung transplantation?

When do you entertain a diagnosis of HLA-negative antibody mediated rejection in lung transplant recipients?

In what clinical scenarios do you utilize post cardiac arrest targeted temperature management (TTM)?

In the span between the Hypothermia After Cardiac Arrest Trial (HACA, 2002) and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest ...

How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?

When do you consider the use of corticosteroids in patients diagnosed with EVALI?

What is your approach to volume resuscitation in patients with obvious septic shock but also with a component of suspected cardiogenic shock?

What is your approach to the use of acetazolamide in patients with OSA?

What is your preferred first line treatment for chronic fatigue in patients with long Covid?

Are you using genomic classifiers to diagnose UIP when imaging is indeterminate or suggestive of an alternate diagnosis?

How are you navigating approval of CPAP for patients with a high suspicion for OSA on chronic oxygen who are unable to complete an in-lab PSG?

Is it safe to combine mycophenolate and adalimumab for management of pulmonary sarcoidosis in a patient that could not tolerate methotrexate?

Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?

What is your approach to initial work up for a young patient with bronchiectasis?

Do you ever initiate pirfenidone in patients with CTD-ILD?

Do you diagnose obstruction by the criteria of FEV1/FVC < 70% or < LLN?

Do you prescribe bronchodilators to patients with radiographic emphysema and respiratory symptoms, but no spirometric obstruction?

Are there preferred home exercise programs for patients without access to pulmonary rehabilitation?

What is your initial treatment of choice in patients with RA and associated interstitial lung disease?

Do you attempt more aggressive PEEP titration to improve the P/F ratio prior to proceeding with proning in patients with ARDS and P/F <150?

Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?

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?

How do you manage GI side effects related to CFTR modulator therapy?

Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?

Do you consider dual biologic therapy in patients with ABPA that remain steroid dependent despite the use of omalizumab?

How do you approach the use of chronic azithromycin in patients with CF who may require therapy with IV tobramycin in the future?

Given the suggestion of the antagonistic effect of azithromycin on IV tobramycin in prior studies.

When do you screen for pulmonary hypertension in ILD patients?

What strategies do you employ to prevent post-intubation hypotension in a profoundly hypoxic patient given a paralytic for intubation?

What strategies do you employ to minimize the risk of cardiovascular collapse when intubating a patient with severe pulmonary hypertension?

Do you favor awake intubation in these cases?

Do you recommend transfer to an institution with a PE response team for a patient with an intermediate risk PE?

Is there a role for the use of biologics as steroid sparing agents in treating patients with ABPA who are intolerant to prednisone?

What is your approach to using nintedanib in patients on baseline immunosuppression?

Patients on baseline mycophenolate and azathioprine were excluded from the INBUILD trial however many patients with CTD-ILD will be on some form of im...

What is your preferred steroid sparing agent in the treatment of Sjögren associated LIP?

What is your approach towards management of symptomatic broncholithiasis?

What factors do you consider while deciding between bronchoscopic vs surgical management?

Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?

Would you place an IVC filter in a patient with an acute intermediate risk PE and a proximal DVT who is on anticoagulation?

Is there any utility in using lytics for loculated malignant pleural effusion?

Would you consider the use of dual antifibrotic therapy (nintedanib and pirfenidone together) for progressive fibrosing ILD?

Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?

How are you using artificial intelligence in your clinic, if at all?

Do you routinely start full dose anticoagulation in new onset atrial fibrillation in the ICU?

Do you rule out TB in patients with AIDS and lobar pneumonia?

What’s your threshold to get the three AFBs and place the patient in airborne isolation?

Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?

Do you transfuse platelets prior to central line placement in patients with platelet counts less than 50,000?

What is your approach to PEEP titration in the management of a morbidly obese patient with ARDS?

Do you routinely use inhaled pulmonary vasodilators in the management of patients with ARDS with refractory hypoxemia?

Do you use sitting vs supine spirometry to consider tracheostomy in a patient with Amyotrophic Lateral Sclerosis?

Which hemodynamic parameters can be used to titrate positive pressure ventilation in preload dependent settings such as RV failure, cardiac tamponade, HOCM or hemodynamically significant PE?

How do you approach treating mild hypercalcemia in patients with sarcoidosis?

How would you manage a patient with morbid obesity who presents with new symptomatic pulmonary embolism a few days after he was started on DOAC for DVT?

What is your preferred anticoagulation in patients with BMI >50?

Do you perform spontaneous breathing trials on higher levels of PEEP with extubation to positive pressure ventilation in patients intubated for obesity hypoventilation syndrome?

Do you routinely use hypertonic saline for pulmonary toileting in patients with non-CF bronchiectasis?

Is an early chest tube and tPA/Dornase therapy for a loculated and complex pleural effusion that is not an empyema or hemothorax helpful in reducing the rate of developing trapped lung?

What are your top takeaways from ATS 2023?

Do you start steroid therapy in a patient with pure ARDS without septic shock, or would you only consider steroids only in those with severe community acquired pneumonia?

To help interpret clinical applications of the CAPE COD (2023) and DEXA ARDS (2020) trials.

How do you manage diarrhea in a patient with CTD-ILD on MMF who was recently started on full dose nintedanib?

How do you sequence pharmacologic treatments for primary insomnia?

When do you begin antifibrotic therapy for a patient with newly diagnosed ILD that is not IPF?

Do you base the decision on FEV1, 6MWD or symptoms at initial evaluation, or progression over time?

Do you routinely continue using TPA/Dornase for treatment of empyema, if there is accumulation of new sero-sanguinous output from the chest tube after the initial treatment?

Are there any quantitative indices (eg. volume, pleural fluid hematocrit) that would impact your decision to stop subsequent TPA/dornase treatments?

What indicators do you use to determine whether a patient is having a favorable or unfavorable response to nintedanib?

When adding nintedanib what sort of treatment course do you counsel the patient on? Do you plan to continue it indefinitely as long as the patient tol...

Do you generally recommend starting nintedanib prior to immunosuppressive therapy in a patient with CTD-ILD?

Do you prefer to start with nintedanib and then add immunosuppressive agents, or give a trial of immunosuppressive medication first, then add nintedan...

What is your approach to management of elderly patients with cardiopulmonary comorbidities and severe pulmonary hypertension?

Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?

What is your threshold to start stress dose steroids in the management of patients with septic shock?

Do you do start therapy at a certain vasopressor requirement?

How do you define an adequate EBUS when staging NSCLC?

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

Are you using NAC in lieu of hypertonic saline amidst the current shortage of hypertonic saline in patients with either CF or non-CF bronchiectasis?

What is your approach to the monitoring and management of a never-smoker with respiratory symptoms and a nonspecific ventilatory pattern on pulmonary function testing?

What dose and duration of steroid therapy do you use in steroid responsive ILD?

What is your next step in management for a patient with immunotherapy induced pneumonitis that does not improve on high dose steroids for 48 hours?

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

Do you employ the use of noctournal oximetry to assess for a need for supplemental O2 in addition to auto PAP in patients with OSA who have not had an in lab CPAP titration study?

Do you continue methotrexate while starting TNFi therapy in patients with refractory pulmonary sarcoidosis?

How do you choose between azithromycin and roflumilast in the management of a patient with severe COPD who remains symptomatic with frequent exacerbations despite maximal dose LABA/LAMA/ICS with demonstrated compliance and proper inhaler technique?

How do you approach treatment of septated parapneumonic pleural effusions that do not satisfy traditional criteria for complicated effusion after diagnostic thoracentesis?

Is there any role of tube thoracostomy as opposed to only antibiotics?

How do you define severe hypoxic burden on home sleep testing?

What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?

What is your perspective on the role of respiratory therapists in managing a patient who is dyssynchronous on their current mode of mechanical ventilation?

Do your respiratory therapists independently adjust ventilator settings without direct physician involvement?

Do you offer immunosuppression to patients with CTD-ILD with concomitant well controlled HIV?

For NSCLC patients with limited diagnostic tissue that is insufficient for genetic testing, do you offer repeat biopsy (of accessible site), blood based testing, or both to evaluate for actionable driver mutations?

What is the role for "liquid biopsy" for patients with newly diagnosed metastatic NSCLC?

Are you using the microbial cell-free DNA “Karius” test to aid in the diagnosis of an atypical pulmonary infection such as PJP or NTM?

Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?

How do you approach which risk to accept given that steroids have evidence for use in COVID-19 while is suggestion for harm in using steroids in influ...

Do you use prednisone in the management of patients with persistent respiratory symptoms following acute COVID-19 infection?

How do you manage recurrent inflammatory pleural effusions in lupus pleuritis?

What is your approach to counseling a patient with exertional hypoxia, but normal resting oxygen saturation, who is hesitant to use supplemental oxygen therapy?

How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?

For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...

What steroid regimen do you employ prior to extubating a patient who does not have a suitable cuff leak?

What is your approach to therapy for pulmonary sarcoidosis resistant to methotrexate?

What steroid regimen do you use in patients with both septic shock and ARDS?

Do you use hydrocortisone 200 mg/day as studied in ADRENAL/APROCCHSS or dexamethasone 20 mg/day as studied in DEXA-ARDS?

How would you treat a patient with combined pre- and post-capillary pulmonary hypertension after successfully optimizing post-capillary pressures through a valvular intervention?

Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?

Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...

Is there any role for palliative radiation in patients who are intubated due to malignant airway obstruction?

Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...

Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?

Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?

What is your approach to pulmonary vasodilator therapy in patients with COPD and Severe Group 3 Pulmonary Hypertension?

Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?

Do you continue CFTR modulator therapy in patients with extra-pulmonary manifestations of CF after lung transplant?

What are your preferred ventilatory settings/mode(s) for patients with acute hypoxic respiratory failure presenting with severe biventricular dysfunction in cardiogenic shock?

Does your approach to the management of a patient with an acute exacerbation of CPFE where the ILD is attributed to IPF differ from the management of a patient with an exacerbation of IPF alone?

Would you restart prophylactic anticoagulation in a patient with a history of unprovoked PE who received short term anticoagulation with a prior physician?

E.g. low dose DOAC

What is your preferred management for diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)?

Does your management change if symptomatic or asymptomatic?

How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?

Do you routinely use donor derived cell free DNA levels to guide surveillance bronchoscopies in lung transplant recipients?

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

Is there a role of everolimus or capecitabine and temozolomide in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in patients already on octreotide?

What is your approach to therapy in patients with progressive Scedosporium pulmonary infection who are not candidates for surgical debridement?

How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

Do you routinely use milrinone to augment RV function in patients with massive pulmonary emboli on vasoactive support?

How do you approach management of limited stage SCLC in a patient with idiopathic pulmonary fibrosis?

What is your approach to the management of a patient with PAH who is resistant to contraception and planning a pregnancy?

Are there known biomarkers predictive of IRAEs?

Do you routinely use sweat tests if you are going to titrate a CF patient onto a lower dose of ETI for any reason (allergy, mental health, etc) to assess the severity of their response to the lower dose?

Are there any concerns utilizing apremilast for psoriatic arthritis in patients who are also taking roflumilast for COPD?

Do you prescribe antifibrotics to patients with combined pulmonary fibrosis and emphysema (CPFE)?

When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?

(Normal oxygenation and echo)

Is there any PFT criteria that you use in guiding decision making to offer transbronchial lung cryobiopsy to patients with interstitial lung disease?

What are your top takeaways from CHEST 2022?

Do you favor the use of maximal inspiratory/expiratory pressure measurement or supine spirometry in the evaluation of a patient with suspected respiratory muscle weakness?

What is your approach to counseling and management of patients with severe symptomatic OSA whose PAP devices have been recalled?

Do you treat Candida spp isolated from a bronchoalveolar lavage?

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?

Do you start PAP in patients who have an overall AHI of less than 5 but demonstrate significant apneas/hypopneas in REM sleep?

What is your approach to the work up and management of interstitial lung abnormalities?

How do you approach performing EBUS TBNA in patients with latex allergy?

Apart from removing the latex balloon, do you employ any additional technical accommodations?

Do you routinely continue airway clearance therapies in the setting of mild to moderate hemoptysis in a patient with CF?

Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?

Do you often see clinical improvement that is significant enough to de-list patients with CF for transplant after the initiation of CFTR modulator therapy?

Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?

Do you perform a clamp trial before removing a chest tube for pneumothorax?

Do you do recommend further mediastinal staging for patients with SCLC or inoperable NSCLC with N1 disease on PET?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

What patient characteristics would lead you to opt for triple therapy versus double therapy in newly diagnosed PAH?

Do you give intrapleural lytics for complicated effusion/empyema in patients on systemic anticoagulation?

What steroid regimen do you employ in the treatment of patients with post COVID-19 pulmonary fibrosis?

Do you ever employ the use of prolonged periods of pressure support ventilation as means of "weaning" in the management of patients with acute respiratory failure?

How would you manage subclinical ILD associated with MDA-5 Dermatomyositis?

Any indications for triple therapy in the patients with subclinical ILD associated with MDA-5 dermatomyositis?

Would you consider PLEX for patients with DAH from SLE-associated capillaritis?

How frequently do you monitor LFTs and CBC after initiating endothelin receptor antagonists?

Is there a difference in monitoring frequency for legacy drugs like bosentan vs newer agents (macitentan, ambrisentan)?

Do you find that complete interlobar fissures on HRCT correlate well with decreased collateral ventilation on endoscopic balloon occlusion in the evaluation and placement of endobronchial valves for bronchoscopic lung volume reduction?

Do you favor the use of Fick or thermodiluation to measure cardiac output in patients with interstitial lung disease with suspected pulmonary hypertension?

Occasionally, supplemental oxygen may alter Fick measurements giving falsely high CO and falsely low PVR, therefore is Thermodilution method preferred...

Which images do you routinely request when ordering a HRCT chest?

In a patient with history of pneumonectomy would you consider SBRT for treatment of a new tumor in the remaining lung?

How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

When do you consider Balloon Pulmonary Angioplasty in patients with inoperable CTEPH?

Do you consider extensive clot burden as a factor in determining whether patients with submassive PE may be appropriate for thrombolytic therapy?

Do you consider endobronchial valve lung volume reduction in patients with homogenous emphysema?

Do you consider the use of bevacizumab in patients with HHT who have high output cardiac failure related to liver AVMs who also have cerebral AVMs?

What workup do you do for patients who have PL-7 elevation when screening for myopathy?

Do you routinely perform genetic testing in patients presenting with pulmonary fibrosis who endorse a family history of fibrotic lung disease?

Do you recommend the use of endobronchial valves in the management of patients with spontaneous pneumothorax with persistent air leak?

What are your top takeaways in Thoracic Cancers from ASCO 2022?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?

Do you recommend the use of indwelling pleural catheters in the management of patients with hepatic hydrothorax requiring frequent drainage?

What criteria do you use to consider pleurodesis vs indwelling tunneled catheters in patients with malignant pleural effusion?

How do you counsel patients regarding prognosis following a diagnosis of IPF?

How do you approach a thoracic lymph node that is highly suspicious on CT and PET but negative on EBUS in patients with NSCLC?

Is there a role for immunosuppression in addition to standard PAH therapy in the management of pulmonary hypertension associated with primary Sjogrens syndrome?

Assuming other non CTD related causes for PAH have been excluded

Do you adjust immunosuppression in lung transplant recipients diagnosed with COVID-19?

Is there a role for the use of inhaled corticosteroids in patients with pulmonary sarcoidosis who have stage II or III disease with abnormal lung function but only mild respiratory symptoms?

How do you clinically distinguish between group I and group III PH in patients with CTD-ILD?

Do you utilize soluble IL-2 receptor or ACE levels as serum biomarkers to monitor disease activity in pulmonary sarcoidosis?

Based on findings of the INCREASE trial, are you routinely prescribing inhaled treprostinil to patients with group 3 pulmonary hypertension secondary to interstitial lung disease?

How do you manage a stenotic airway following SBRT or hypofractionated radiation to a central lung tumor?

Are there situations in which you would recommend dilation of stenotic airways after radiation? Is there a concern for increased complications of dila...

How do you treat patients with sarcoid who have persistent symptoms after an initial 6 week course of corticosteroids?

Do you consider the use of antifibrotics at presentation in patients with a radiographic UIP pattern of pulmonary fibrosis in the presence of positive serologies without any symptoms of CTD (ie, fulfilling a possible diagnosis of IPAF) who have not yet demonstrated evidence of a progressive phenotype?

Do you de-escalate airway clearance therapies in patients with CF who experience an improvement in mucus production and clearance after CFTR modulator therapy is started?

Do you employ the use of extracorporeal photopheresis in the management of patients with progressive BOS following lung transplantation?

Clinical trial NCT02181257 to explore this currently in process

Do you employ the use of external chest compression with sandbags in the management of patients with severe ARDS who are not candidates for proning?

When would you consider biopsy for an incidentally noted, PET negative, solid, solitary pulmonary nodule that is >8mm in size?

Is there a role for antifibrotic therapy in post COVID-19 pulmonary fibrosis?

Do you use intrapleural tPA/dornase in loculated effusions that are not due to infection?

Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?

What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

What is your approach to treatment for a patient with progressive ILD (UIP pattern) with high titer RF but no articular symptoms?

Would you advise a patient with quiescent vasculitis who flared with the first Covid mRNA vaccine to obtain an additional dose?

Would you suggest switching to a viral vector vaccine, such as J&J?

Would you offer adjuvant chemotherapy, osimertinib, or both to a patient with Stage IB EGFR mutated lung adenocarcinoma found in the lung explant pathology after bilateral lung transplant?

Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?

How do you treat multisystem sarcoidosis refractory to methotrexate, humira, and remicade?

What strategies can be employed to manage interstitial lung disease seen with trastuzumab deruxtecan?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use? Do you feel the dosing used in...

How would you approach treatment for fulminant RA-associated ILD?

Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...

What are your recommendations regarding methotrexate usage in patients with persistent chest CT changes post COVID pneumonia?

Would you have a different opinion based on whether it is a new therapy or an existing and previously well-tolerated therapy for the patient?

How do you evaluate a suspicious, but negative pleural effusion when working up NSCLC and SCLC?

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

What is your approach for disease activity monitoring in patients with sarcoidosis?

Do you routinely recommend a sleep study in patients with clinical history of REM-sleep behavior disorder?

Does this add any value?

What criteria do you use on echocardiogram and PFT to determine who needs further evaluation for CTD-associated pulmonary hypertension?

What indicators do you use to identify patients with CTD-ILD who do not have potential to improve from continued immunosuppressive therapy?

Do you use imaging (fibrosis vs. pneumonitis), PFTs, duration of prior immunosuppressive therapy?

What is your preferred regimen for remission induction and maintenance in EGPA with cardiac involvement?

How do you approach patients with ANCA vasculitis who had partial response, but continue to have disease activity on q 6 month maintenance rituximab and remain on steroids?

Would you change rituximab maintenance dose or schedule?

How do you choose between oral and IV cyclophosphamide for the treatment of ANCA-associated vasculitis?

What is your approach for a symptomatic inpatient with locally advanced NSCLC who cannot have a PET?

Would you consider treating the full mediastinum or any mildly enlarged nodes, even contralateral? Do you have a strategy that transitions from a pall...

What immunosuppressive agents aside from steroids would you use to treat bronchiolitis obliterans in a patient with long-standing seropositive RA?

How do you approach the management of SSc-ILD in a patient on immune checkpoint therapy?

Would you use inhaled steroids with or without oral steroids for the treatment of radiation pneumonitis?

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering? If s, for what pneumonitis grade? What specific steroid...

How do you treat an AAV patient with recurrent bronchial stenosis that has not responded to rituximab induction therapy and dilatations?

Are there any concerns about using nintedanib in a patient with progressive fibrosing ILD on background mycophenolate?

Is positive pleural fluid cytology from pleural mesothelioma considered M+?

Should patient be considered for definitive therapy or chemo alone if pleural cytology positive but no T4, N2, or sarcomatoid features?

How do you treat CTD-associated organizing pneumonia?

How is your approach to treatment different than other ILD patterns such as NSIP? Does treatment response vary based on underlying CTD?

How will you use tocilizumab in the treatment algorithm for SSc-ILD, given its recent FDA approval?

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

How do you manage end-organ toxicity such as hepatotoxicity or pulmonary toxicity in a patient receiving RET-inhibitors for NSCLC?

What is your approach to treatment for MDA5 dermatomyositis patients with rapidly progressive ILD?

Cyclophosphamide/tacrolimus and Rituximab have been used in conjunction with steroids in case series.

Is there a role for anti-IL6 therapy in SSc-associated ILD?

Are there AAV patients for whom you would consider combination therapy with cyclophosphamide and rituximab?

Can liquid biopsy be substituted for tissue biopsy in a lung mass that is radiologically suspicious for primary lung cancer when CT-guided biopsy cannot be done?

For example, a patient with a large (>3cm), spiculated, FDG-avid lung lesion, who has poor lung function and is refusing a CT-guided biopsy?

What is considered an adequate treatment period to assess response of AAV induction therapy with rituximab or cyclophosphamide?

Which EGPA patients are most likely to benefit from treatment with anti-IL-5 agents such as mepolizumab?

What steroid sparing agent do you use for treatment of cardiac sarcoidosis?

Does the type of cardiac involvement impact this choice?

Should MTX be avoided in RA patients with asymptomatic lung nodules?

If so, what would be an ideal DMARD in this setting?

What is the optimal management of patients with stage II lung cancer without nodal metastasis, but unresectable due to poor pulmonary reserve?

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

Do you consider cystic fibrosis a contraindication to lung SBRT for primary NSCLC or oligometastases?

How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

Which ANCA vasculitis patients are better candidates for cyclophosphamide rather than rituximab?

Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?

This question is part of a collaboration with RheumMadness and is in reference to: Pathogenic ANCARAVE Trial

How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?

Are there certain subsets of ANCA vasculitis patients for whom you would consider life long maintenance therapy?

When a patient presents with 2 lung lesions, do you routinely recommend a biopsy of both lung lesions?

Would your practice change if the patient had N2 disease?

Should methotrexate be categorically avoided in RA patients with COPD or RA-ILD?

How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?

What clinical factors do you use to determine timing of on-demand dosing of rituximab in ANCA vasculitis maintenance therapy?

Do you recommend on-demand versus fixed-schedule dosing for rituximab maintenance in ANCA vasculitis?

If you use both, how do you decide which to use for a particular patient?

What is the role of nintedanib in the treatment of SSc-ILD?

The SENSCIS trial was published in 2019 on efficacy of this agent. However, it's not clear where this should be in the treatment algorithm: Monot...

When do you use tacrolimus in patients with myositis-related interstitial lung disease?

How do you manage early and symptomatic fibrosis in lung cancer patients after RT?

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumon...

Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?

What agent do you try next in patients with myositis-related interstitial lung disease who are refractory to mycophenolate mofetil and azathioprine?

When do you stop immunosuppressants in patients with GPA?

What is your next step in patients with polymyositis without interstitial lung disease who are refractory to methotrexate?

Is there an increased risk of pneumonitis in COVID-19+ patients receiving lung irradiation?

Any differences in the risks between SBRT vs. conventionally fractionation? Concurrent immunotherapy?

How do you treat extensive stage small cell lung cancer in the very elderly (more than 80 yrs)?

Do you use an age limit cutoff for SBRT in lung cancer?

Is there a certain age beyond which it is not safe to do SBRT?

How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?

Should staging and treatment decisions be made based on imaging alone?

How would you treat a patient with extensive-stage small cell carcinoma and severe end-stage COPD on home oxygen?

Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?

In a patient with ILD and metastatic NSCLC with positive PD-L1, would you give chemo/pembrolizumab, chemotherapy alone, or pembrolizumab alone?

Does the degree of PD-L1 expression weigh into your decision?

How do you approach elderly patients with stage III NSCLC who have a reasonable performance status?

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?

Is IO related pneumonitis in the radiation field or more diffuse?

What is your approach for a primary tracheal squamous cell carcinoma?

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Should patients with idiopathic pulmonary fibrosis be placed on nintedanib or pirfenidone before starting radiotherapy for lung cancer?

How important is a severely diminished diffusion capacity in determining whether to offer a lung cancer patient radiotherapy?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

How would you manage palliation in a patient with postobstructive pneumonia caused by a mediastinal mass?

Would you treat if there is active infection? How much improvement would you expect?

How are you using liquid biopsy in the routine management of your patients with metastatic NSCLC?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

How do you approach the workup of subcentimeter contralateral nodules in cases of locally advanced NSCLC?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

What factors do you consider to help guide treatment for patients with high grade large cell neuroendocrine cancers of the lung?

Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...

How do you manage an adult primary rhabdomyosarcoma of the lung/mediastinum?

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

Do you consider idiopathic pulmonary fibrosis a contraindication to lung SBRT?

There are varying reports in the literature which seem to suggest increased rates of Gr 4-5 pneumonitis in IPF patients. How do you manage these...

Do you use anti-PD-1/anti-PD-L1 therapies in lung cancer patients with a prior history of radiation pneumonitis?

What about patients who are still on steroids for radiation pneumonitis?

When is it considered inappropriate to omit pathological mediastinal lymph node staging for non-small cell lung cancer?

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < ...

When do you start steroids for radiation pneumonitis?

Following lung RT, I have rarely seen patients present with pneumonia-like symptoms of radiation pneumonitis. I'm more likely to see a patient with wo...

How do you approach lung tumors with vessel encasement, especially in someone with active hemoptysis?

Is there any concern about hemorrhage from treatment effect on tumor? Would SABR worsen the chance of fatal hemorrhage/hemoptysis and if so, would you...

What are your criteria for treating a patient with lung SBRT in the absence of a biopsy?

Roughly what percentage of patients are treated without a biopsy?

If a PET/CT scan is positive for mediastinal lymph node involvement, is a mediastinoscopy or EBUS still required for NSCLC staging?

In practice, do you send patients with N2/3 disease for mediastinal staging if not offered upfront?