Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
When interpreting pulmonary function tests (PFTs), do you include diagnostic language such as 'findings are suggestive of COPD,' or do you limit your report to a descriptive interpretation of the data?
My viewpoint is that PFT interpretation should focus on interpreting physiology. This is especially important in areas like airway diseases, where a post-bronchodilator FEV1/FVC ratio showing obstruction could be due to a host of diseases. If the interpreter puts that is suggestive of COPD without t...
Do you always get a baseline chest xray in patients who will be starting methotrexate?
I believe it is a good practice for screening CXR before Mtx to document baseline findings, which will help to register if there is some baseline issues.
How do you mitigate risk when performing bronchoscopy in hypoxic patients requiring high levels of supplemental oxygen?
The first question you have to ask yourself, is 'why am I doing this'? If the answer is not going to significantly alter management (i.e. removal of a foreign body, bronchus plug; or biopsy to alter drug therapy) then it would be wise to defer until the patient is more stable. If it is deemed the pr...
Do you use sitting vs supine spirometry to consider tracheostomy in a patient with Amyotrophic Lateral Sclerosis?
The decision to pursue tracheostomy is becoming less of a choice altogether in our practice. However, to answer your question once my patients are on NIPPV I don't routinely subject patients to supine spirometry for prognostic follow-up, given the high risk-benefit ratio of transferring a patient wi...
Is there any role for prophylactic bronchial artery embolization in immunocompromised patients with invasive pulmonary aspergillosis?
Bronchial artery embolization is NOT without complications. Although the bleeding risk is very high in invasive pulmonary aspergillosis, empirical embolization is not well supported either by data or clinical practice. It probably should be a case-by-case decision.
Is there a risk of hepatitis C activation with rituximab in a patient who has a history of HCV treated with antivirals and who is in sustained viral response?
In general, the risk of HCV flare with immunosuppression in general including rituximab must be viewed as minimal for those who have achieved a sustained virologic response (Undetectable HCV RNA ≥12 weeks after treatment completion) and does not influence my therapeutic decision-making if the patien...
Would you give T-DXd to patients with resolved drug-induced ILD from other agents such as prior chemo/targeted therapy/immunotherapy?
Depending on the pathophysiology and prior offending agent, I would consider treating such patients with TDxd. Ado-trastuzumab emtansine has been rarely associated with ILD; in this particular case, ILD caused by another HER2-targeting ADC, unless it was grade 1, I may not consider challenging the p...
Do you wait until serum anti-GBM antibody titers are undetectable before hospital discharge in a patient with anti-GBM antibody disease with renal involvement who is receiving daily plasmapheresis, cyclophosphamide, and steroids?
If such a patient is responding to treatment, titers are declining, is otherwise doing well, and does not have extra-renal issues that would require hospitalization, for example, an ongoing oxygen requirement for lung involvement, they could be managed as an outpatient if pheresis can be arranged. I...
Have you adopted the use of low dose morphine for treatment of cough in patients with IPF?
Yes, I selectively use low-dose morphine for the treatment of chronic cough (lasting more than 8 weeks) in certain patients with idiopathic pulmonary fibrosis (IPF).This includes individuals who demonstrate somewhat preserved lung function (specifically, a forced vital capacity [FVC] of 45% or more ...
Should the RSV vaccine be administered to pregnant mothers even if it is not seasonally circulating but they are 32-36 weeks pregnant?
Here is the official CDC/ACIP recommendation (accessed 3/30/2025): "CDC recommends one dose of Pfizer’s Abrysvo for women who are 32 0/7 weeks’ through 36 6/7 weeks’ gestation. Pregnant women who are more than 36 weeks 6 days pregnant should not be vaccinated, as it is unlikely there will be enough ...