Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
What are your top takeaways from CHEST 2025?
1. Pulmonary Hypertension: From Basics to Bedside and Theory to Therapy This postgraduate course provided an exceptional deep dive into pulmonary vascular disease through interactive, small-group learning and expert-led case discussions. The integration of hemodynamic interpretation, risk stratifica...
How do you approach the use of benzodiazepines in patients with chronic medical illnesses that may be susceptible to respiratory compromise (e.g., CHF, COPD, ILD)?
It’s a very good question and answers may vary among different specialty providers. Yes, a slow or gradual weaning of the benzodiazepines would be advisable. When they reach lower doses the taper should be even slower over weeks or longer. There is a risk for not weaning them off benzodiazepines inc...
When you interpret a PFT officially, do you include a comparison to an older PFT on your report?
Yes, I use as much information as is readily available in my PFT interpretations. Comparison with older PFTs enables me to track changes in pulmonary function; for example, changes in FVC are particularly important in individuals with pulmonary fibrosis who are undergoing antifibrotic therapy. I als...
Do you routinely treat pregnant patients for latent tuberculosis or delay treatment until 2-3 months post-partum?
Guidelines from CDC, WHO, ATS/IDSA recommend delaying the treatment of latent TB in pregnancy until 2-3 months postpartum unless there is a high risk of progression to TB disease e.g. HIV co-infection. This is because the risk of hepatotoxicity from isoniazid is higher during pregnancy and in the ea...
When might you soften the post-thrombolysis monitoring requirements for patients receiving TPA for acute stroke?
The recent study by Anderson et al., PMID 40412428, suggests that a pattern of reduced monitoring after tPA was noninferior to standard monitoring in patients with initial NIHSS < 10, treated within 2 hours of symptom onset. This is suggestive that the reduced monitoring protocol is safe in patients...
How do you decide between oral vs nasal route of entry for bronchoscopy with BAL with moderate sedation?
I trained in the early 90s. Where I trained the nasal route of entry was preferred. My experience is that patients cough less, require less sedation, and the scope is easier to guide and direct from the "stable" base of a nasal insertion. With proper nasal preparation complications related to nasal ...
What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?
Based on recent studies and evidence in the literature, my preferred approach for venting the left ventricle in patients on VA-ECMO would be guided by the individual patient's clinical scenario, with a cautious inclination towards using the intra-aortic balloon pump (IABP) over Impella. This prefere...
What further evaluation do you pursue for patients who present with vague symptoms such as subjective fevers or intermittent night sweats, who have no pulmonary symptoms but have a positive IGRA?
Great question. Another scenario that is not uncommon is some degree of cough, sometimes for long periods of time, but no other symptoms. If their risk is higher for progression to active disease (e.g., immunocompromised; recent contact with an active case) I may do more than if the risk is low. My ...
How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?
I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors). For severely symptoma...
Do you avoid use of inhalers with milk protein in patients with a milk allergy?
According to the Advair Diskus package insert, “Immediate hypersensitivity reactions may occur after administration of ADVAIR DISKUS, as demonstrated by cases of urticaria, angioedema, rash, and bronchospasm. There have been reports of anaphylactic reactions in patients with severe milk protein alle...