Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
What is your preferred steroid sparing agent in the treatment of Sjögren associated LIP?
There is unfortunately very limited data comparing the efficacy of various steroid-sparing agents for the treatment of connective tissue disease-related ILD, and no large prospective studies have specifically addressed the ideal approach for patients with underlying Sjogrens. Mycophenolate and azath...
Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?
I use only intermittent.
How do you approach the use of chronic azithromycin in patients with CF who may require therapy with IV tobramycin in the future?
This question has been somewhat analyzed in the TEACH study comparing coadministration of azithromycin and inhaled tobramycin. The authors found no difference in lung function but higher pseudomonas CFU reduction in patients treated with inhaled tobramycin alone. In the situation of IV tobramycin fo...
How do you manage GI side effects related to CFTR modulator therapy?
We have found that for most patients liver enzymes abnormalities are small and transient; however, for about 1% of patients there are severe elevations and these patients are much more difficult to manage, even after withdrawal, and tough to re-challenge; it is also not patients with severe liver di...
What is your approach to the management of a patient with idiopathic pneumonia syndrome following stem cell transplant who does not demonstrate clinical improvement with steroid therapy?
Continue with good supportive care including diuresis, lung protective ventilation strategies for intubated patients, and a thorough evaluation for infection as retrospective studies have shown a relatively high rate of infection even in cases where the infection was considered to be ruled out (Seo ...
Are there preferred home exercise programs for patients without access to pulmonary rehabilitation?
There is Pulmonary Rehab toolkit on the pulmonary fibrosis foundation website. I will generally show it to patients and have them bookmark it on their phones.
Does your approach to extubating obese patients differ from your approach in non-obese patients?
If the patient has OSA/OHs I often extubate directly to CPAP OR bipap especially if they have high compliance to OSA cpap therapy and are "used to the mask". But if high levels of secretions, NIV can make clearance of secretions more difficult. Thus, individualize therapy is indicated.
When do you entertain a diagnosis of HLA-negative antibody mediated rejection in lung transplant recipients?
What therapies do you routinely use to prevent mucus plug formation after endobronchial stent placement?
After airway stent placement, especially silicone stents and/or Y stents, I start my patients on albuterol neb BID; hypertonic saline neb BID, and NAC neb BID. If there are any issues with adherence, I use either albuterol + hypertonic saline or albuterol + NAC depending on patient preference. If th...
Did the low rate of COPD exacerbations in the BOREAS cohort overall confound the results of the study?
I feel that the results are still very impressive despite this.