Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
What dose and duration of steroid therapy do you use in steroid responsive ILD?
This is an extremely challenging question to answer as "steroid-responsive lung disease" encompasses a variety of formal and informal diagnoses as well as a variety of different clinical scenarios. Additionally, the dose and duration of corticosteroids would depend on patient factors and comorbid co...
What are your top takeaways from ISHLT 2024?
I had the privilege of attending ISHLT 2024, and I am delighted to share insights from three standout presentations that I believe will significantly influence our field.1. Trifecta Heart Study by Dr. Philip HalloranImpact: This presentation explored innovative blood-based techniques such as cell-fr...
Do you utilize robotic bronchoscopy to biopsy a lung cavity wall?
This is not a straightforward question with a simple answer. Depending on what’s suspected for the patient, robotic bronchoscopy can certainly be used for the biopsy of the wall of a cavity. For example, if lung cancer is suspected and no other metastatic sites are noted, a biopsy of the wall is war...
When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?
In general, the standard approach is to try to wait as long as possible after the thrombotic event, at the very least three months. This may not be possible, we then reduce that time interval to one month. Given the urgent nature of the surgical intervention, one approach is to wait one month and co...
Do you diagnose obstruction by the criteria of FEV1/FVC < 70% or < LLN?
Using lower limit of normal for FEV1/FVC ratio may reduce misclassification of airway obstruction but despite years of discussion and arguments it remains unclear whether it is a better approach. The simplicity of the fixed ratio approach to me remains a very important consideration and it is the ap...
Would you restart prophylactic anticoagulation in a patient with a history of unprovoked PE who received short term anticoagulation with a prior physician?
The decision on duration of anticoagulation should balance the risk of hemorrhage vs risk of recurrent VTE. The annual risk of recurrence with unprovoked venous thromboembolism (VTE) is definitely higher than provoked VTE and seems to be higher in males than females.According to one study (Rodger et...
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 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 ...