Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
When do you pursue interventional treatments in a lung transplant patient with anastomotic dehiscence complicated by a bronchopleural fistula?
Very small areas of dehiscence are typically managed conservatively with serial bronchoscopy for observation. However, for larger areas of dehiscence associated with a higher risk of mediastinal or pleural infection, we typically opt for mechanical debridement and airway stent placement to cover the...
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?
Nocturnal hypoxemia noted on ONO on CPAP doesn't qualify patients for supplemental oxygen. I usually check ONO on CPAP on symptomatic patients who are also on daytime oxygen to assess the adequacy of supplemental oxygen at night.
How do you approach management of a patient with Sjogren's disease and lung mass biopsy revealing amyloidosis?
A lung mass showing amyloid in SjD may reflect systemic amyloid or local/focal amyloid. Interdisciplinary assessment is recommended (Fraenkel et al., PMID 34101376). Organ systems involved will guide the expertise needed.Immunohistochemistry and molecular studies are needed to define if there is an ...
What is your approach to inhaler therapy in a patient with asthma who cannot be on an inhaled corticosteroid due to ocular disease?
I use LABA/LAMA combination.
What are your criteria for treating a patient with lung SBRT in the absence of a biopsy?
First I would say that there is no standard answer to this, and the crtieria are going to depend on your population and the experience of you and your colleagues.. The group at VU has published their experience treating "clincially diagnosed" early lung cancer with SBRT, and found that the outcomes ...
How do you approach lung tumors with vessel encasement, especially in someone with active hemoptysis?
It's a good question and not one that has a ton of published data to support. If you look at the GYN literature for palliation of vaginal bleeding, hypofractioned RT can be a very useful treatment, suggesting a role in other sites. My impression is always that those are very vascular malignanies and...
When should SBRT be preferred in operative patients who cannot undergo a lobectomy?
Numerous retrospective studies have examined clinical outcomes between SBRT and surgery using a variety of different statistical tests- propensity analyses, matched-pair comparisons, multivariable analyses, and so forth. Collectively, these studies report conflicting results. No randomized data with...
Do you use anti-PD-1/anti-PD-L1 therapies in lung cancer patients with a prior history of radiation pneumonitis?
I have used anti-PD-1 directed therapies in patients with a prior history of radiation pneumonitis. The history had excluded her from one clinical trial of these agents but not another that is also combining the anti-PD-1 directed therapy with a CTLA-4 agent. If someone is on steroids for a current...
Do you consider idiopathic pulmonary fibrosis a contraindication to lung SBRT?
The number of IPF patients treated at our institution has been relatively small, at less than 5%. When they have presented with medically inoperable early lung cancer, we have discussed the risk and benefits of lung SBRT with a focus on lung toxicity that may be more prevalent in this clinical scena...
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?
There is an excellent answer to this question from my colleague Dr. @Dr. First Last that can be found here. She provides an overview of the data as well as multiple references.