Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
What indicators do you use to determine whether a patient is having a favorable or unfavorable response to nintedanib?
Unfortunately, there probably isn't a way to do this. It might be helpful to step back and see what nintedanib buys you: as compared to placebo, the nintedanib group suffered less FVC decline by ~110mL/year. Real-world data suggest there's probably a mortality benefit if you have your patients on it...
Do you always comment on VA and KCO when reading PFT's when gas transfer is ordered?
I do not. I look at the VA to see if it meets ATS criteria ( [1] >=90% of largest VC in the session; or >=85% and within 200cc or 5% of the largest VC; [2] breath hold of 10 +/- 2 sec; [3] >=85% of inh ventilation inhaled in <4sec)
Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?
Yes, I do.
Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?
My approach to patients with high respiratory drive is variable based on the disease process, the patient's physiology, and the stage of evolution of the disease. Optimization of ventilation parameters (inspiratory flow rate, flow pattern, cycle time, trigger settings) to promote synchrony is a firs...
Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?
The short answer is yes. CDC recommends applying airborne isolation for any "suspected" case of TB. So if you suspect, you should isolate until you rule out with 3 negative AFB or have an alternative diagnosis. Keep in mind pretest probability and risk factors for that patient with the miliary patte...
Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?
Yes, along with Remdesivir, Tamiflu, Bactrim, and supportive care. If there is active GGO on CAT scan, steroids are usually beneficial. Start high and then taper to the lowest necessary for about a 10-day course.
Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?
The simple answer will be: NO.
Do you rule out TB in patients with AIDS and lobar pneumonia?
Depends: +Ve Risk Factors: Travel/contact Hx, recent Quantiferon Conversion, changing CXR, Night sweats Unexplained low-grade temps Then, yes. Otherwise, no.
Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?
With the increasingly common indication of progressive pulmonary fibrosis in the setting of CT-ILD, RA, and scleroderma, it is conceivable that patients being started on antifibrotic therapy may be on anti-TNF alpha or other immunosuppressive agents. Specifically with anti-TNF alpha agents such as R...
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?
No, not at this time. Intriguing, but not sure we know enough yet.