Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
Do you have any pearls for how to manage OSA with CPAP in older adults with cognitive impairment?
I try to involve a partner or other family member in the process, including getting a sleep study in the first place. If the study shows moderate or severe sleep apnea, especially with substantial oxygen desaturation, I remind the patient and partner that use of CPAP will help the patient's memory. ...
What is the best alternative oral therapy for treatment of non-severe pulmonary nocardiosis in an immunocompetent patient with sulfa allergy?
We have been using linezolid for this indication, based on a paper from ARUP Labs.Schlaberg et al., PMID 24247124
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?
I use end-expiratory wedge pressure (and all hemodynamics for that matter at end-expiratory pressure) most of the time which is supported by current guidelines. The confounder is in patients with wide transthoracic pressure swings (i.e., exercise, severe COPD, severe obesity). This is just something...
Do you ever consider continuing annual LDCT chest for lung cancer screening in patients who quit smoking more than 15 years ago?
The 15 years is now 20 years but keep in mind the “Guidelines” may not apply to the patient in front of you. Did anyone else notice that 2nd hand smoke is not in the eligibility criteria?
How do you weigh the benefit of urinary catheter placement for strict I/O measurement with the risk of avoidable CAUTI?
Our hospital's approach, which is consistent with CDC guidance, limits urinary catheters (UC) for I/O measurement to critically ill patients. We clarify that the information from the UC should be used at least q1-2 hours, otherwise it can be obtained in other ways (noninvasive collection, bladder sc...
How do you treat idiopathic hypersomnia inadequately responding to modafinil?
I agree with @Dr. First Last. I usually start my patients on modafinil or armodafinil. If those do not work, I will try solriamfetol. I will supplement with as needed amphetamines as well. I do not often go straight to sodium oxybate/low-sodium oxybate, as you need the right patient for this medicat...
Do you treat complicated pneumonia with a drained empyema longer if Streptococcus anginosus is cultured, either in isolation or with other organisms, compared to cases in which it is not?
Targeted antimicrobial therapy for any bacterial etiology of an empyema will be individualized for each patient but a general duration of 4-6 weeks. I would not consider strep anginosus differently in this regard. What I am looking for is adequacy of drainage with clinical improvement. Radiographic ...
How do you manage hypercalcemia in sarcoidosis despite being on immunosuppressive therapy?
Let us accept, first, that the individual does not have emergent levels of elevated calcium (equal to around or greater than 14 mg/dl) and concerning symptoms of the following systems: neurological (e.g., weakness, confusion, delirium), renal (e.g., polyuria, polydipsia), gastrointestinal (e.g., los...
When would you consider glucocorticoids as adjunctive therapy for for community-acquired pneumonia outside of the ICU setting?
Thank you for bringing this new study to my attention; I hadn't seen it yet. After reviewing the article, my practice regarding steroids remains unchanged. While the trial was well-executed, and it is laudable to see such research coming out of a limited-resource setting, that environment differs si...
How would you approach treatment of latent TB for patients who cannot tolerate rifamycins or isoniazid due to allergy, intolerance, or drug-drug interactions?
Levofloxacin or moxifloxacin. Duration is 6-9 months.