Pulmonology&nbsp;&nbsp;&nbsp;

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

How do you manage daytime somnolence without a clear cause?

E.g., negative sleep study, good sleep hygiene, no offending medications, no psychiatric disorder.

What is your approach to helping parents manage sleep disturbances in patients with autism spectrum disorder?

When would you recommend prescribing an asthmatic patient budesonide/salbutamol rather than budesonide/formoterol?

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)?

Should you work to wean patients of benzodiazepines? Is your approach different for patients who have been on benzodiazepines for years? What would yo...

4 Answers available

How do you monitor safety, effectiveness, and adherence to therapy when using sedative hypnotics in patients with insomnia?

Do you require patients to complete a controlled substance agreement or obtain routine interval urine drug screens?

How do you sequence pharmacologic treatments for primary insomnia?

What duration of antibiotic therapy do you use for a loculated parapneumonic effusion that does not meet criteria for empyema?

Do you ever consider continuing annual LDCT chest for lung cancer screening in patients who quit smoking more than 15 years ago?

Unlike USPTF and CMS guidelines, NCCN and ACS do not have a criterion for <15 years since quit

How long do you recommend that a patient wear a mask when resuming biologic infusions following a recent upper respiratory infection?

How do you manage persistent pseudomonas positive sputum a patient with non-CF bronchiectasis who has chronic sputum production but is otherwise asymptomatic?

Do you feel high dose Symbicort or Dulera is appropriate to use for SMART despite these doses not being studied in clinical trials?

What factors do you consider prior to offering a trial of ICS/LABA therapy versus a methacholine challenge test in patients with suspected asthma but normal pulmonary function testing?

Will you incorporate the use of tirzepatide in the management of patients with OSA?

The recently published SURMOUNT-OSA trial showed positive results

Should in-office oscillometry for lung function measurements be utilized in pediatric patients who are unable to reliably perform spirometry?

What is your approach to prescribing RIPE for 6 month vs rifapentine/moxifloxacin for 4 months in the treatment of drug sensitive TB in the US?

What is your approach to de-escalation of asthma inhaler therapy in the setting of negative bronchoprovocation testing when patients are averse to deprescribing?

At times due to limited testing resources, inhaler therapy is started based on clinical suspicion of asthma and bronchoprovocation testing is done lat...

Do you ever consider tapering off steroid-sparing agents in patients with stable non-IPF ILD?

Do you perform routine interval screening for renal angiomyolipomas in patients with sporadic LAM?

How do you approach management of osteoporosis in patients post lung transplant?

How do you manage resistant infections that persist after stopping antibiotic therapy in patients with non-CF bronchiectasis?

How often do you monitor pulmonary function tests in patients with fibrotic lung disease?

At what age do you stop LDCT chest for lung cancer screening?

USPTF and CMS guidelines differ in age criteria, and NCCN guidelines do not have an upper age limit.

How do you manage persistent insomnia despite ASV titration in patients with complex sleep apnea?

Which patient characteristics or scenarios drive you to choose tezepelumab over dupilumab for asthma?

What is your approach to the use of Paxlovid for patients with risk factors for severe Covid-19 infection but who have received SARS-CoV-2 vaccines in light of the EPIC-SR trial findings?

EPIC-SR Trial

Do you grade severity of OSA by AHI or RDI?

5 Answers available

Do you perform routine interval screening for pulmonary fibrosis in individuals who have been identified through genetic testing as being at risk for developing pulmonary fibrosis but don't exhibit any signs or symptoms?

Specifically considering individuals with known mutations in MUC5B, TERT/TERC, etc

How would you manage symptomatic, bilateral subsegmental PE developed after long air travel?

The patient takes frequent flights for their job, with no prior history of VTE, and has already been taking measures for prevention including frequent...

Do you avoid use of inhalers with milk protein in patients with a milk allergy?

What is your approach to evaluation and management of GERD in a patient with IPF?

Will you incorporate ensifentrine in the treatment regimen of patients with COPD on baseline dual or triple inhaler therapy?

Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?

What is the minimum daily duration of supplemental oxygen therapy you recommend to patients with chronic hypoxic respiratory failure?

Do findings from the REDOX Trial comparing 24 vs 15 hours of supplemental oxygen influence your approach?

What is the current recommendation for air travel after a primary spontaneous pneumothorax?

How do you counsel and manage patients who meet criteria for sleep apnea based on 3% but not 4% desaturation?

How would you approach treatment of latent TB for patients who cannot tolerate rifamycins or isoniazid due to allergy, intolerance, or drug-drug interactions?

What is your approach to de-escalation of asthma therapy if patients have remained clinically stable on triple inhaler therapy and a biologic agent?

Is there a role for nocturnal supplemental oxygen as opposed to no therapy in patients with OSA who are unable to tolerate PAP therapy?

Do you start PAP in patients who have an overall AHI of less than 5 but demonstrate significant apneas/hypopneas in REM sleep?

Is there a role for the use of transient elastography (FibroScan) to monitor liver fibrosis in patients on long term methotrexate?

Is there a role for biologics to improve lung function in patients who have severe asthma with daily symptoms and reduced lung function but do not experience frequent exacerbations?

Is Metformin contraindicated in patients using long term oxygen therapy at home?

Liang et al., PMID 35900801

How do you approach medication management in biopsy-proven pulmonary sarcoidosis with disease stable for over 2 years on hydroxychloroquine and low dose prednisone?

Do you discontinue HCQ?

Do you give additional pneumococcal vaccines after a dose of PCV20 in patients with asplenia?

What is your approach to tapering therapy in patients with pulmonary sarcoidosis who are asymptomatic with stable pulmonary function and imaging?

What is your approach to counseling and management of patients with severe symptomatic OSA whose PAP devices have been recalled?

Do you adhere to the standard 5-day minimum treatment duration for community-acquired pneumonia, or have you used shorter courses for certain low-risk patients?

What dose and duration of steroid therapy do you employ while starting mycophenolate in an outpatient with relatively stable CTD-ILD?

Do you ever start mycophenolate without steroids?

Do you perform routine interval lung cancer screening in non-smokers who are 1st degree relatives of patients with non-smoking related lung cancers with known EGFR mutations?

What is your approach to counseling patients regarding re-initiation of anti-TNF therapy after completion of treatment for non-disseminated pulmonary histoplasmosis?

Would it be safe to resume and if so, when?

For how long do you recommend treatment for latent tuberculosis prior to initiation of anti-TNF therapy?

Do you routinely perform genetic testing in patients presenting with pulmonary fibrosis who endorse a family history of fibrotic lung disease?

How do you follow pulmonary embolism patients who have completed anticoagulation?

How are you navigating approval of CPAP for patients with a high suspicion for OSA on chronic oxygen who are unable to complete an in-lab PSG?

How do you navigate PAP approval for patients with tracheobronchomalacia or excessive dynamic airway collapse who do not have OSA?

Do you consider skin involvement associated with tattoos to be a marker of disease activity and an indication to start treatment in a patient with sarcoidosis?

What is your approach to the use of acetazolamide in patients with OSA?

How do you approach treating and monitoring sarcoidosis manifested by maxillary bone/teeth loss without other symptoms?

How do you define severe hypoxic burden on home sleep testing?

What is your approach to inhaler therapy in a patient with asthma who cannot be on an inhaled corticosteroid due to ocular disease?

Is there an age at which you consider not starting antifibrotic therapy in a patient with IPF?

What is your approach for disease activity monitoring in patients with sarcoidosis?

What is your approach to the management of symptomatic Cystic Fibrosis carriers?

What is your threshold to start triple therapy in mild to moderate asthma/COPD overlap with minimal functional limitation?

What patient factors prompt you to consider starting dupilumab in patients with COPD?

Does active smoking status influence this decision?

How long do you continue surveillance with imaging and sputum cultures in a patient with NTM with no indications for treatment?

Do you prescribe bronchodilators to patients with radiographic emphysema and respiratory symptoms, but no spirometric obstruction?

Are there preferred home exercise programs for patients without access to pulmonary rehabilitation?

When do you screen for pulmonary hypertension in ILD patients?

Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?

How do you approach treating mild hypercalcemia in patients with sarcoidosis?

What indicators do you use to determine whether a patient is having a favorable or unfavorable response to nintedanib?

When adding nintedanib what sort of treatment course do you counsel the patient on? Do you plan to continue it indefinitely as long as the patient tol...

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?

How do you choose between azithromycin and roflumilast in the management of a patient with severe COPD who remains symptomatic with frequent exacerbations despite maximal dose LABA/LAMA/ICS with demonstrated compliance and proper inhaler technique?

Do you use prednisone in the management of patients with persistent respiratory symptoms following acute COVID-19 infection?

4 Answers available

What is your approach to counseling a patient with exertional hypoxia, but normal resting oxygen saturation, who is hesitant to use supplemental oxygen therapy?

Would you restart prophylactic anticoagulation in a patient with a history of unprovoked PE who received short term anticoagulation with a prior physician?

E.g. low dose DOAC

Are there any concerns utilizing apremilast for psoriatic arthritis in patients who are also taking roflumilast for COPD?

Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?

How frequently do you monitor LFTs and CBC after initiating endothelin receptor antagonists?

Is there a difference in monitoring frequency for legacy drugs like bosentan vs newer agents (macitentan, ambrisentan)?

Do you de-escalate airway clearance therapies in patients with CF who experience an improvement in mucus production and clearance after CFTR modulator therapy is started?

Would you advise a patient with quiescent vasculitis who flared with the first Covid mRNA vaccine to obtain an additional dose?

Would you suggest switching to a viral vector vaccine, such as J&J?

Do you routinely recommend a sleep study in patients with clinical history of REM-sleep behavior disorder?

Does this add any value?

Should MTX be avoided in RA patients with asymptomatic lung nodules?

If so, what would be an ideal DMARD in this setting?

Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?

If there are a low-risk patients who can be monitored, how would you do so? If unprovoked, would you consider stopping anticoagulation?

Should methotrexate be categorically avoided in RA patients with COPD or RA-ILD?

How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?