Pulmonology&nbsp;&nbsp;&nbsp;

Which biomarkers or diagnostic tools do you prioritize to support the decision to start antifungal treatment in septic patients with no clear source of infection but at high risk for fungal infections?

Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?

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

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

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

Do add a macrolide for immunomodulatory effect in patients with macrolide-resistant M. abscessus?

Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?

Data on the role of steroids in HIV negative patients with PJP has been conflicting.

Do you grade severity of OSA by AHI or RDI?

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

Do you use or recommend clinical severity scores or other parameters in helping prognostication in patients with refractory status epilepticus?

What is your hemoglobin target for PRBC transfusion in cases of acute brain injury?

Have recent trials (TRAIN trial and HEMOTION trial) influenced your approach?

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

What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?

For example, is captopril dialyzable?

What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?

7 Answers available

Do you recommend early oral nutrition when managing diabetic ketoacidosis?

Some data showed early enteral nutrition improves outcomes in DKA. Some thought that enteral nutrition could counteract the insulin gtt.

Would you offer lung SBRT in a patient with Pulmonary Langerhans Cell Histiocytosis (PLCH)?

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?

Do shorter door-to-balloon (D2B) times impact outcomes in STEMI, if it's already less than 90 minutes, and to what degree (i.e., 30 vs 60 minutes would have a more significant impact)?

Do you consider the use of tocilizumab in patients with COVID pneumonia who have had an improvement in supplemental O2 requirements but have significantly elevated inflammatory markers after day two of remdesivir and dexamethasone?

What is your approach to differentiating RA-ILD from medication toxicity (I.e. from methotrexate)?

Do you routinely perform a pre-extubation bronchoscopy for secretion clearance during the index hospitalization in patients following lung transplantation?

What is your diagnostic approach to patients referred for central sleep apnea on PSG but normal overnight EEG and MRI?

What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?

What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

Are there clinical scenarios in which you would start empiric treatment for pulmonary TB without microbiologic confirmation?

Are you using genomic classifiers to diagnose UIP when imaging is indeterminate or suggestive of an alternate diagnosis?

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

Do you consider tracheostomy for the management of continued hypercapnea despite compliance with PAP in patients with OHS and OSA?

Have you adopted the use of low dose morphine for treatment of cough in patients with IPF?

If so, what dose and formulation of morphine do you prefer?The PACIFY COUGH trial utilized controlled-release morphine 5 mg BID, however the lowest do...

What is your approach to evaluation and diagnosis following a non-diagnostic MSLT in a patient with suspected narcolepsy type 2?

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.

What is the upper limit of blood glucose target in hyperglycemic critically ill patients?

The new SCCM guidelines suggest an upper limit of 200 compared to the conventional 180.

How do you identify which patients are at highest risk for decompensation and most likely to benefit from NIV for pre-oxygenation prior to intubation?

Does the experience level of the intubation operator affect outcomes related to pre-oxygenation with NIV versus an oxygen mask?

Does the use of NIV for pre-oxygenation delay the time to intubation?

Do you administer immunosuppression to patients with idiopathic NSIP who have normal lung function and mild to moderate respiratory symptoms?

What are your top takeaways from CHEST 2024?

What factors do you consider for patients on an individual basis when establishing a post-cardiac arrest MAP goal after ROSC is achieved, considering some may benefit from higher MAP goals for optimal cerebral perfusion?

In cases of intermediate-risk pulmonary embolism, what factors influence your decision to pursue catheter-directed thrombolysis?

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

How do you approach the bronchoscopic evaluation of a cavitary lesion of the lung?

Do you routinely perform transbronchial biopsies in addition to BAL in all cases?

What postural change in FVC is suggestive of respiratory muscle weakness?

How do you manage patients with central sleep apnea due to heart failure with reduced ejection fraction?

Are there specific scenarios in which you employ BPAP with a back up rate?

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?

How do you approach a patient with sarcoidosis who cannot tolerate steroids and who is developing ILD?

Do you use TNF-i or MMF?

How do you read a PFT with restrictive type spirometry but normal lung volumes?

What clinical significance does this have and how do you follow these patients?

Do you monitor CBCs to assess for drug toxicity in patients on nintedanib?

What blood pressure targets do you enforce in the first 24-48 hours in a patient who develops an intracranial hemorrhage after mechanical thrombectomy?

Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...

What recommendations do you have regarding the use of dronabinol to prevent cannabis withdrawal in an inpatient medical or psychiatric setting?

Would you treat a sputum culture positive for Aspergillus niger despite an atypical CT chest and a negative serum galactomannan in an immunosuppressed patient who is too high risk for bronchoscopy?

0 Answers available

How do you approach management of ILD in the presence of weakly positive RF and ANA but no other objective systemic findings of connective tissue disease?

Is this managed as CTD-ILD with immunosuppressive +/- anti-fibrotic agents?

In a patient with low titer +anti-SAE antibody and known ILD, but no other clinical features of dermatomyositis, how would you approach further testing or would you treat the patient as dermatomyositis associated ILD?

What are the logistical challenges and time constraints of implementing NIV for pre-oxygenation in emergency settings compared to oxygen masks?

Would bag-mask ventilation with a PEEP valve be a reasonable alternative to NIV for pre-oxygenation prior to intubation in settings where NIV is not easily accessible?

Is there a subset of patients in whom pre-oxygenation with NRB or BVM could be safely pursued?

Do you perform EBUS-TBNA for staging in patients with biopsy proven malignant lung nodules with no lymphadenopathy on CT chest and PET scan?

Al-Ibraheem et al., PMID 33731050

Do you consider surgical thrombectomy in patients with a large, obstructive pulmonary venous thrombosis after lung transplant?

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

How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

7 Answers available

Would you add abatacept to treat active inflammatory arthritis in a patient with history of RA-ILD who is already taking mycophenolate?

Do you administer calcium to patients with K > 6.5 without EKG changes?

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

When attempting PEEP titration, how long do you wait after decrements or increments to assess for a change in driving pressure?

Do you routinely perform echocardiography in patients with Staphylococcus aureus bacteremia deemed low risk for metastatic infection, or do you selectively omit it based on specific clinical criteria?

Hendriks, et al., PMID 38576380

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

How do you decide between oral vs nasal route of entry for bronchoscopy with BAL with moderate sedation?

How small of a nodule would you attempt to biopsy with robotic bronchoscopy?

What criteria do you use to determine when to start a steroid-sparing agent for hypersensitivity pneumonitis?

How would you manage a patient with ANCA associated vasculitis who has recurrent flare including pulmonary hemorrhage, persistent MPO antibody positivity while on maintenance rituximab and avacopan regimen even after induction rituximab therapy?

What are first-line choices for vasopressors/inotropes to use in hypotensive patients with Eisenmenger Syndrome?

Do you start immunosuppression for enlarging pulmonary nodules without symptoms, impaired pulmonary function, or extra-pulmonary disease in a patient with sarcoidosis?

Do you obtain a MSLT or start empiric therapy with modafinil in patients with residual excessive daytime sleepiness despite optimal adherence to PAP therapy?

In patients with average of less than 5 respiratory events per hour, adequate sleep duration and hygiene confirmed on sleep log, absent cataplexy and ...

How do you workup patients with neuropathy suspected to be secondary to sarcoid?

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

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 would be your recommendation for treatment of worsening lung disease in a patient with long-standing scleroderma after long-term mycophenolate therapy which is no longer an option due to side effect/intolerance?

Have you noticed poor response to Tyvaso DPI compared to the nebulized form in PH-ILD?

Could the intrinsic inspiratory capacity and distribution of medication be different between the two routes?

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

How do you determine the severity of restrictive lung disease?

How do you approach determining appropriateness for extubation in a patient with acute respiratory failure in the setting of known chronic neuromuscular disease?

Do you hold anticoagulation prior to performing bronchoalveolar lavage?

Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?

Do you preferentially avoid use of piperacillin-tazobactam for empiric anti-pseudomonal coverage in hospitalized patients due to risk of nephrotoxicity?

ACORN Randomized Clinical Trial

Would you consider adding or switching to pirfenidone for a patient with progressing UIP (based on imaging and PFTs) who is currently on nintedanib?

Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?

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

How would you manage a patient with morbid obesity who presents with new symptomatic pulmonary embolism a few days after he was started on DOAC for DVT?

What is your preferred anticoagulation in patients with BMI >50?

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

Is methacholine challenge on its way out?

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?

How would you approach the workup and management of isolated inflammatory subglottic stenosis in a young previously healthy patient that is steroid responsive with a completely negative serologic autoimmune workup?

Would you push for biopsy before deciding on treatment?

In which cases would you consider early transition to DOAC (within 72 hours) for hospitalized patients with intermediate or high risk PE?

Assume thrombolytics are not indicated. Do you favor early DOAC transition after 24-48 hours of heparin gtt or do you favor LMWH for 10-14 days follow...

How do you approach management of new onset ILD in a patient with RA who is otherwise well controlled on methotrexate or leflunomide?

How would you manage cardiac sarcoid with intolerance/contraindications to methotrexate, azathioprine, and mycophenolate/mycophenolic acid and that has proven refractory to adalimumab and infliximab as determined by PET?

Would you initiate antifibrotic therapy in a patient with CTD-ILD experiencing worsening symptoms and declining lung function, despite no clear evidence of fibrosis on CT scans?

CT changes are subsolid and ground glass nodules.

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

Liang et al., PMID 35900801

How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?

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?

What is your approach to radiographically suspicious lung nodules for which initial biopsy was negative for malignancy?

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

In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD? How frequently do you monitor osmolarity?

Do you utilize phrenic nerve EMG in patients with diaphragmatic issues?

How do you approach the treatment of indeterminate UIP on HRCT with grossly positive MPO antibody and no other features consistent with AAV?

Can transudative pleural effusions lead to trapped lung?

In trapped lung, a fibrous peel over the visceral pleura restricts pleural expansion. Could transudative pleural effusions lead to this condition?

What is your preferred third antimicrobial agent for a patient with treatment-naive pulmonary MAC without cavitary disease and strict contraindications to utilization of rifampin or rifabutin?

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

The recently published SURMOUNT-OSA trial showed positive results

In drawing blood cultures from a central line to evaluate for CLABSI, do you advise drawing separate blood cultures from each port in case of dual or triple lumen line?

If yes, what is the rationale for doing that?

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

Do you continue to prone patients with severe ARDS after initiation of VV-ECMO?

Can intra-abdominal pressure serve as a surrogate for pleural pressure to titrate PEEP in obese patients or those with intra-abdominal hypertension?

Is the adage “If GCS <8, intubate” still relevant for non-TBI patients?

Do the findings of the NICO trial influence your stance?

Do you consider administration of nintedanib or pirfenidone via enteral tube in patients unable to take PO due to recurrent aspiration?

Would a metal endobronchial stent within the treatment field change your radiation treatment plan for a thoracic malignancy?

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

How does the presence of interstitial lung disease affect your decision to offer SBRT for early stage NSCLC?

Specifically in O2-dependent patients? Have any dose/fractionation regimens been shown to reduce the risk of pneumonitis in this population?

When do you consider ketamine to treat nonconvulsive status epilepticus?

Do you favor aggressive airway clearance regimens or bronchoscopy for clearing occluding mucous plugs in patients who are not in respiratory distress?

Have you used Karius to aid in the diagnosis of a non-resolving pneumonia, with negative bronchoscopy, biopsy, and other infectious work up in an immunocompetent patient?

Is there still a role for direct laryngoscopy in the intubation of patients in the ICU?

Multiple recent trials have shown higher first pass success rate with VL over DL.

Have you incorporated the use of linezolid in lieu of vancomycin plus clindamycin for empiric treatment of necrotizing fasciitis?

Do you administer prophylactic antibiotics to prevent VAP following intubation in patients with acute brain injury?

Do the findings of the PROPHY-VAP trial influence your approach?

Is there increased risk with lung SBRT in a patient who has a mild asymptomatic pneumothorax in the field after CT-guided needle biopsy?

When do you consider the use of steroids in the management of acute exacerbations in patients with cystic fibrosis?

Do you always comment on VA and KCO when reading PFT's when gas transfer is ordered?

Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?

Do you consider use of convalescent plasma early in disease course in COVID-19 induced ARDS in mechanically ventilated patients?

Do the results of the recent study (Misset et al., PMID 37889107) showing reduction in 28-day mortality in patients with high neutralizing antibody ti...

Do you favor the use of maximal inspiratory/expiratory pressure measurement or supine spirometry in the evaluation of a patient with suspected respiratory muscle weakness?

Is there any utility to trending Histoplasma serology titers to guide duration of therapy or treatment response for pulmonary histoplasmosis with negative urine antigen?

How do you factor smoking history into biologic selection for asthma since the clinical trials generally excluded these patients?

Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?

How do you decide between neoadjuvant or perioperative chemoimmunotherapy, as per Checkmate 816 or KEYNOTE-671, for early-stage NSCLC?

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 is your approach to withdrawal of ventilatory support at the end of life?

Do you favor gradual reduction in oxygen and pressure support with intermittent medication as needed or immediate extubation with peri-extubation medi...

What is your approach to management of pulmonary fibrosis in patients with a history of microscopic polyangiitis who do not have other active organ involvement?

Patient is with past history of glomerulonephritis in remission after rituximab for the past 2 years. +MPO/P-ANCA

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?

What is the expected timeframe one would expect to see paroxysmal sympathetic hyperactivity/sympathetic storming persist post-traumatic brain injury?

For example, in the setting of TBI, how do you guide the duration of the medical treatment?

What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?

Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...

Is there a risk of hepatitis C activation with rituximab in a patient who has a history of HCV treated with antivirals and who is in sustained viral response?

How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

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?

How would you approach a pulmonary-renal PR3+ ANCA vasculitis patient who has persistent re-narrowing of mainstem bronchus after several dilatation and stenting procedures, with other anca features well-controlled on rituximab & avacopan?

Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?

Do you assess telomere length in all patients with IPF prior to lung transplant?

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?

Would you consider deferring chest tube placement in a clinically stable patient with a small empyema without signs of systemic infection?

Is a larger bore percutaneous chest tube sufficient to adequately drain a hemothorax, or is a surgical chest tube required?

Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?

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

What is your approach to the evaluation and management of a suspected intrapulmonary hematoma?

What agents do you utilize for mucociliary clearance during the index hospitalization of patients post lung transplant?

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

What serologic biomarkers do you send to assess for sarcoidosis at baseline and/or during flares, in patients where it may correlate with disease activity?

Specifically, do you check for any of these: ACE, Vitamin D 1,25, serum lysozyme, soluble IL2 or Adenosine deaminase levels?

Do you use intrapleural tPA/dornase in loculated effusions that are not due to infection?

How do you assess the use of Heimlich valves for patients who present with persistent air leaks?

How do you approach management of adult patients with CVID and sarcoid-like syndrome?

Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?

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

Would you stop azathioprine in a patient with ANCA vasculitis who has been in long term remission on azathioprine, but has a new diagnosis of lung cancer requiring initiation of immunotherapy?

What are your top takeaways from ISHLT 2024?

Do you ever consider close clinical monitoring over antifibrotic therapy in patients ascribed an MDD diagnosis of IPF who have normal lung function and are asymptomatic?

Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

Seethapathy et al., NEJM

How do you manage concurrent nonlife-threatening hemoptysis and acute pulmonary embolism?

Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...

Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

Do you utilize robotic bronchoscopy to biopsy a lung cavity wall?

How do you manage diarrhea in a patient with CTD-ILD on MMF who was recently started on full dose nintedanib?

Have you incorporated the use of steroids for patients with severe community-acquired pneumonia?

In light of published data from the CAPE COD trial...

Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?

Do you diagnose obstruction by the criteria of FEV1/FVC < 70% or < LLN?

When do you consider the use of PH specific therapies in patients with pre-capillary pulmonary hypertension associated with sickle cell disease?

Do you treat A0B1 rejection noted on surveillance bronchoscopy in a patient less than one year post lung transplant?

Is there a role for chronic suppressive oral or inhaled therapy for recurrent Burkholderia cepacia pneumonia causing frequent hospitalizations in a patient with severe bronchiectasis with or without underlying cystic fibrosis?

Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?

Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?

In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?

In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...

Do you use hypercapnia as an exclusion criteria in all patients that are being assessed for bronchoscopic lung volume reduction?

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

Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?

What approaches can we take to initiate therapy and improve survival rates in patients with HLH?

Do you use any drugs prophylactically to reduce the risk of radiation pneumonitis in lung SBRT?

Would you provide pentoxyphylline and vitamin E prophylactically after treatment? Is there a role for Boswellia? ACE inhibitor?

Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?

In which patients do you prefer daily standard three-drug therapy for non-cavitary pulmonary MAC as opposed to three times a week dosing?

What protective post-op measures do you recommend for a patient with scleroderma and a history of ILD, PH, Raynaud’s and digital ischemia undergoing cardiothoracic surgery?

In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?

What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...

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?

Would you start any treatment for radiation pneumonitis if there is a large area of consolidation in the irradiated lung field but the patient is asymptomatic?

Would you consider pentoxifylline and vitamin E to mitigate fibrosis?

Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?

Do you obtain an echocardiogram as a part of risk stratification in all patients hospitalized with an acute pulmonary embolism?

How do you approach biologic initiation in patients with inflammatory arthritis and repeatedly indeterminate Quantiferon?

How do you approach patients with RA and severe bronchiectasis with associated findings of UIP?

How do you determine if pulmonary hypertension is disproportionate to the severity of lung disease?

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

When do you pursue interventional treatments in a lung transplant patient with anastomotic dehiscence complicated by a bronchopleural fistula?

What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?

What is your approach to the management of persistent hydropneumothorax due to a non expandable lung?

What patient factors, if any, would lead you to extubate a patient at high risk of extubation failure to AVAPS rather than BIPAP?

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

What factors do you consider while selecting high risk patients for prophylactic NIV after planned extubation?

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

In light of the RECITAL study, would rituximab be a reasonable choice in a patient with PL-12 antibodies, rapidly progressive pulmonary disease with organizing pneumonia on biopsy?

Given poor pulmonary outcomes in people with anti-PL12 antibodies, would you recommend more aggressive therapy? The patient was diagnosed with onset o...

How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?

What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?

Would you restart sirolimus for a decline in lung function or pneumothoraces in a pregnant patient with LAM?

How do you risk stratify patients with different WHO groups of pulmonary hypertension prior to non-cardiac surgeries?

And who would you not recommend to undergo surgeries?

What would be your second pressor of choice if patients with LVOT obstruction remain persistently hypotensive on phenylephrine?

How would you manage asymptomatic osseous sarcoidosis of the lumbar spine without any other systemic involvement?

Would you use with DMARDs/biologics or monitor?

Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

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

Do you perform PEEP titration while patients are proned?

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

Do you consider immunosuppressive agents in progressive interstitial pneumonias or pneumonitis without a clear driving etiology?

Do you add fludrocortisone to hydrocortisone when starting stress dose steroids in a patient with septic shock?

Though there is data to support using both hydrocortisone and fludrocortisone, it seems to be used rarely in clinical practice. A review publishe...

Do you consider pulmonary hypertension related to sarcoidosis to be an indication to start steroids?

Do you use biomarkers or PET scanning to stratify patients who may benefit most from therapy?

How would you approach medication de-escalation in a patient with a history of rapidly progressive CTD-ILD who responded to and is currently on mycophenolate 3 grams daily and IVIG 2mg/kg monthly infusions and has been stable for two years?

Does your approach to extubating obese patients differ from your approach in non-obese patients?

How do you approach management of a patient with Sjogren's disease and lung mass biopsy revealing amyloidosis?

Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?

How do you approach management of a patient with idiopathic PAH and +ANA, but no other current symptoms/signs of active rheumatologic disease?

Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

Is it safe to combine mycophenolate and adalimumab for management of pulmonary sarcoidosis in a patient that could not tolerate methotrexate?

When should SBRT be preferred in operative patients who cannot undergo a lobectomy?

In other words, if offered wedge or segmentectomy, should SBRT be preferred? Does size matter ie if the lesion is < 3 vs < 2 vs < 1 cm? Does ...

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

How long post operatively do you wait before transitioning from parenteral anticoagulation to oral anticoagulants after pulmonary thromboendarterectomy for CTEPH?

What is your approach to monitoring patients with cardiac sarcoid while tapering immunosuppression?

Do you obtain serial cardiac PET scans?

What is your preferred strategy for controlling bleeding after transbronchial or endobronchial biopsies?

How do you manage immunosuppressive medications in patients who develop a pneumonia?

What therapies do you routinely use to prevent mucus plug formation after endobronchial stent placement?

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

Is dyspnea without radiation pneumonitis a side effect of lung radiation?

Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?

Do you prefer using end-expiratory or mean pulmonary artery wedge pressure obtained during diagnostic right heart catheterization for the classification of precapillary vs postcapillary PH?

What is your approach to steroid sparing therapy in patients with suspected CTD-ILD?

How long do you normally wait before considering any bronchoscopic procedure (EBUS-TBNA, Transbronchial biopsy) after an episode of acute PE in a patient needing these procedures?

Normally, waiting 6-12 weeks of therapeutic anticoagulation after an acute PE is suggested for any bronchoscopic procedure, however there is always a ...

What are your top takeaways from CHEST 2023?

What are best practices in management of severe acute infusion reaction from infliximab?

Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...

What is your approach to a patient who has a cardiac PET scan suggestive of sarcoid but no other supporting evidence of a diagnosis of sarcoid?

Do you typically push for myocardial biopsy in this case?

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

Does active smoking status influence this decision?

Did the low rate of COPD exacerbations in the BOREAS cohort overall confound the results of the study?

Are the results of the BOREAS trial generalizable to non-white populations?

The cohort in the study was predominantly white. Do these results highlight significant disparities in COPD care?

Will you use FeNO testing in all COPD patients to determine whether they are candidates for therapy with dupilumab?

If so, would this be a consideration in all patients regardless of active smoking status? FeNO in active smokers has been questioned, could this have ...

Would you give T-DXd to patients with resolved drug-induced ILD from other agents such as prior chemo/targeted therapy/immunotherapy?

What is your approach in differentiating IPAF (interstitial pneumonia with autoimmune features) versus "CTD ILD" in patients with serologic abnormalities but do not fulfill criteria for autoimmune disease?

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

Have you seen rheumatoid nodules or RA-ILD in patients with seronegative RA?

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

What is the risk of ILD recurrence in MDA5/Ro52 positive dermatomyositis following a lung transplantation?

When do you entertain a diagnosis of HLA-negative antibody mediated rejection in lung transplant recipients?

How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?

When do you consider the use of corticosteroids in patients diagnosed with EVALI?

What is your approach to volume resuscitation in patients with obvious septic shock but also with a component of suspected cardiogenic shock?

Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?

What is your approach to initial work up for a young patient with bronchiectasis?

Do you ever initiate pirfenidone in patients with CTD-ILD?

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?

What is your initial treatment of choice in patients with RA and associated interstitial lung disease?

Do you attempt more aggressive PEEP titration to improve the P/F ratio prior to proceeding with proning in patients with ARDS and P/F <150?

Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?

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?

How do you manage GI side effects related to CFTR modulator therapy?

Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?

Do you consider dual biologic therapy in patients with ABPA that remain steroid dependent despite the use of omalizumab?

How do you approach the use of chronic azithromycin in patients with CF who may require therapy with IV tobramycin in the future?

Given the suggestion of the antagonistic effect of azithromycin on IV tobramycin in prior studies.

When do you screen for pulmonary hypertension in ILD patients?

What strategies do you employ to prevent post-intubation hypotension in a profoundly hypoxic patient given a paralytic for intubation?

What strategies do you employ to minimize the risk of cardiovascular collapse when intubating a patient with severe pulmonary hypertension?

Do you favor awake intubation in these cases?

Do you recommend transfer to an institution with a PE response team for a patient with an intermediate risk PE?

Is there a role for the use of biologics as steroid sparing agents in treating patients with ABPA who are intolerant to prednisone?

What is your approach to using nintedanib in patients on baseline immunosuppression?

Patients on baseline mycophenolate and azathioprine were excluded from the INBUILD trial however many patients with CTD-ILD will be on some form of im...

What is your preferred steroid sparing agent in the treatment of Sjögren associated LIP?

What is your approach towards management of symptomatic broncholithiasis?

What factors do you consider while deciding between bronchoscopic vs surgical management?

Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?

Would you place an IVC filter in a patient with an acute intermediate risk PE and a proximal DVT who is on anticoagulation?

Is there any utility in using lytics for loculated malignant pleural effusion?

Would you consider the use of dual antifibrotic therapy (nintedanib and pirfenidone together) for progressive fibrosing ILD?

Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?

Do you routinely start full dose anticoagulation in new onset atrial fibrillation in the ICU?

Do you rule out TB in patients with AIDS and lobar pneumonia?

What’s your threshold to get the three AFBs and place the patient in airborne isolation?

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

Do you transfuse platelets prior to central line placement in patients with platelet counts less than 50,000?

What is your approach to PEEP titration in the management of a morbidly obese patient with ARDS?

Do you routinely use inhaled pulmonary vasodilators in the management of patients with ARDS with refractory hypoxemia?

Do you use sitting vs supine spirometry to consider tracheostomy in a patient with Amyotrophic Lateral Sclerosis?

What is your second line therapy for patients with EGPA with mainly pulmonary and sinonasal features who did not respond to mepolizumab 300 mg/month and still require high doses of steroid?

Which hemodynamic parameters can be used to titrate positive pressure ventilation in preload dependent settings such as RV failure, cardiac tamponade, HOCM or hemodynamically significant PE?

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

Do you perform spontaneous breathing trials on higher levels of PEEP with extubation to positive pressure ventilation in patients intubated for obesity hypoventilation syndrome?

Do you routinely use hypertonic saline for pulmonary toileting in patients with non-CF bronchiectasis?

Is an early chest tube and tPA/Dornase therapy for a loculated and complex pleural effusion that is not an empyema or hemothorax helpful in reducing the rate of developing trapped lung?

What are your top takeaways from ATS 2023?

Do you start steroid therapy in a patient with pure ARDS without septic shock, or would you only consider steroids only in those with severe community acquired pneumonia?

To help interpret clinical applications of the CAPE COD (2023) and DEXA ARDS (2020) trials.

How do you sequence pharmacologic treatments for primary insomnia?

When do you begin antifibrotic therapy for a patient with newly diagnosed ILD that is not IPF?

Do you base the decision on FEV1, 6MWD or symptoms at initial evaluation, or progression over time?

Do you routinely continue using TPA/Dornase for treatment of empyema, if there is accumulation of new sero-sanguinous output from the chest tube after the initial treatment?

Are there any quantitative indices (eg. volume, pleural fluid hematocrit) that would impact your decision to stop subsequent TPA/dornase treatments?

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 generally recommend starting nintedanib prior to immunosuppressive therapy in a patient with CTD-ILD?

Do you prefer to start with nintedanib and then add immunosuppressive agents, or give a trial of immunosuppressive medication first, then add nintedan...

What is your approach to management of elderly patients with cardiopulmonary comorbidities and severe pulmonary hypertension?

Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?

What is your threshold to start stress dose steroids in the management of patients with septic shock?

Do you do start therapy at a certain vasopressor requirement?

How do you define an adequate EBUS when staging NSCLC?

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

Are you using NAC in lieu of hypertonic saline amidst the current shortage of hypertonic saline in patients with either CF or non-CF bronchiectasis?

What is your approach to the monitoring and management of a never-smoker with respiratory symptoms and a nonspecific ventilatory pattern on pulmonary function testing?

What dose and duration of steroid therapy do you use in steroid responsive ILD?

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?

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

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?

Do you continue methotrexate while starting TNFi therapy in patients with refractory pulmonary sarcoidosis?

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?

How do you approach treatment of septated parapneumonic pleural effusions that do not satisfy traditional criteria for complicated effusion after diagnostic thoracentesis?

Is there any role of tube thoracostomy as opposed to only antibiotics?

What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?

What is your perspective on the role of respiratory therapists in managing a patient who is dyssynchronous on their current mode of mechanical ventilation?

Do your respiratory therapists independently adjust ventilator settings without direct physician involvement?

Do you offer immunosuppression to patients with CTD-ILD with concomitant well controlled HIV?

For NSCLC patients with limited diagnostic tissue that is insufficient for genetic testing, do you offer repeat biopsy (of accessible site), blood based testing, or both to evaluate for actionable driver mutations?

What is the role for "liquid biopsy" for patients with newly diagnosed metastatic NSCLC?

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?

Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?

How do you approach which risk to accept given that steroids have evidence for use in COVID-19 while is suggestion for harm in using steroids in influ...

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

How do you manage recurrent inflammatory pleural effusions in lupus pleuritis?

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

How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?

For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...

What steroid regimen do you employ prior to extubating a patient who does not have a suitable cuff leak?

What is your approach to therapy for pulmonary sarcoidosis resistant to methotrexate?

What steroid regimen do you use in patients with both septic shock and ARDS?

Do you use hydrocortisone 200 mg/day as studied in ADRENAL/APROCCHSS or dexamethasone 20 mg/day as studied in DEXA-ARDS?

How would you treat a patient with combined pre- and post-capillary pulmonary hypertension after successfully optimizing post-capillary pressures through a valvular intervention?

Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?

Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...

Is there any role for palliative radiation in patients who are intubated due to malignant airway obstruction?

Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...

Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?

What is your approach to pulmonary vasodilator therapy in patients with COPD and Severe Group 3 Pulmonary Hypertension?

Do you continue CFTR modulator therapy in patients with extra-pulmonary manifestations of CF after lung transplant?

What are your preferred ventilatory settings/mode(s) for patients with acute hypoxic respiratory failure presenting with severe biventricular dysfunction in cardiogenic shock?

Does your approach to the management of a patient with an acute exacerbation of CPFE where the ILD is attributed to IPF differ from the management of a patient with an exacerbation of IPF alone?

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

What is your preferred management for diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)?

Does your management change if symptomatic or asymptomatic?

How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?

Do you routinely use donor derived cell free DNA levels to guide surveillance bronchoscopies in lung transplant recipients?

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

Is there a role of everolimus or capecitabine and temozolomide in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in patients already on octreotide?

What is your approach to therapy in patients with progressive Scedosporium pulmonary infection who are not candidates for surgical debridement?

How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

Do you routinely use milrinone to augment RV function in patients with massive pulmonary emboli on vasoactive support?

How do you approach management of limited stage SCLC in a patient with idiopathic pulmonary fibrosis?

What is your approach to the management of a patient with PAH who is resistant to contraception and planning a pregnancy?

Are there known biomarkers predictive of IRAEs?

Do you routinely use sweat tests if you are going to titrate a CF patient onto a lower dose of ETI for any reason (allergy, mental health, etc) to assess the severity of their response to the lower dose?

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

Do you prescribe antifibrotics to patients with combined pulmonary fibrosis and emphysema (CPFE)?

When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?

(Normal oxygenation and echo)

Is there any PFT criteria that you use in guiding decision making to offer transbronchial lung cryobiopsy to patients with interstitial lung disease?

What are your top takeaways from CHEST 2022?

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

Do you treat Candida spp isolated from a bronchoalveolar lavage?

Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?

What is your approach to the work up and management of interstitial lung abnormalities?

How do you approach performing EBUS TBNA in patients with latex allergy?

Apart from removing the latex balloon, do you employ any additional technical accommodations?

Do you routinely continue airway clearance therapies in the setting of mild to moderate hemoptysis in a patient with CF?

Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?

Do you often see clinical improvement that is significant enough to de-list patients with CF for transplant after the initiation of CFTR modulator therapy?

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

Do you perform a clamp trial before removing a chest tube for pneumothorax?

Do you do recommend further mediastinal staging for patients with SCLC or inoperable NSCLC with N1 disease on PET?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

What patient characteristics would lead you to opt for triple therapy versus double therapy in newly diagnosed PAH?

Do you give intrapleural lytics for complicated effusion/empyema in patients on systemic anticoagulation?

What steroid regimen do you employ in the treatment of patients with post COVID-19 pulmonary fibrosis?

Do you ever employ the use of prolonged periods of pressure support ventilation as means of "weaning" in the management of patients with acute respiratory failure?

How would you manage subclinical ILD associated with MDA-5 Dermatomyositis?

Any indications for triple therapy in the patients with subclinical ILD associated with MDA-5 dermatomyositis?

Would you consider PLEX for patients with DAH from SLE-associated capillaritis?

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 find that complete interlobar fissures on HRCT correlate well with decreased collateral ventilation on endoscopic balloon occlusion in the evaluation and placement of endobronchial valves for bronchoscopic lung volume reduction?

Do you favor the use of Fick or thermodiluation to measure cardiac output in patients with interstitial lung disease with suspected pulmonary hypertension?

Occasionally, supplemental oxygen may alter Fick measurements giving falsely high CO and falsely low PVR, therefore is Thermodilution method preferred...

Which images do you routinely request when ordering a HRCT chest?

In a patient with history of pneumonectomy would you consider SBRT for treatment of a new tumor in the remaining lung?

When do you consider Balloon Pulmonary Angioplasty in patients with inoperable CTEPH?

Do you consider extensive clot burden as a factor in determining whether patients with submassive PE may be appropriate for thrombolytic therapy?

Do you consider bronchoscopic lung volume reduction in patients with homogenous emphysema?

Do you consider the use of bevacizumab in patients with HHT who have high output cardiac failure related to liver AVMs who also have cerebral AVMs?

What workup do you do for patients who have PL-7 elevation when screening for myopathy?

Do you recommend the use of endobronchial valves in the management of patients with spontaneous pneumothorax with persistent air leak?

What are your top takeaways in Thoracic Cancers from ASCO 2022?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?

Do you recommend the use of indwelling pleural catheters in the management of patients with hepatic hydrothorax requiring frequent drainage?

What criteria do you use to consider pleurodesis vs indwelling tunneled catheters in patients with malignant pleural effusion?

How do you counsel patients regarding prognosis following a diagnosis of IPF?

How do you approach a thoracic lymph node that is highly suspicious on CT and PET but negative on EBUS in patients with NSCLC?

Is there a role for immunosuppression in addition to standard PAH therapy in the management of pulmonary hypertension associated with primary Sjogrens syndrome?

Assuming other non CTD related causes for PAH have been excluded

Do you adjust immunosuppression in lung transplant recipients diagnosed with COVID-19?

Is there a role for the use of inhaled corticosteroids in patients with pulmonary sarcoidosis who have stage II or III disease with abnormal lung function but only mild respiratory symptoms?

How do you clinically distinguish between group I and group III PH in patients with CTD-ILD?

Do you utilize soluble IL-2 receptor or ACE levels as serum biomarkers to monitor disease activity in pulmonary sarcoidosis?

Based on findings of the INCREASE trial, are you routinely prescribing inhaled treprostinil to patients with group 3 pulmonary hypertension secondary to interstitial lung disease?

How do you manage a stenotic airway following SBRT or hypofractionated radiation to a central lung tumor?

Are there situations in which you would recommend dilation of stenotic airways after radiation? Is there a concern for increased complications of dila...

How do you treat patients with sarcoid who have persistent symptoms after an initial 6 week course of corticosteroids?

Do you consider the use of antifibrotics at presentation in patients with a radiographic UIP pattern of pulmonary fibrosis in the presence of positive serologies without any symptoms of CTD who have not yet demonstrated evidence of a progressive phenotype?

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?

Do you employ the use of extracorporeal photopheresis in the management of patients with progressive BOS following lung transplantation?

Clinical trial NCT02181257 to explore this currently in process

Do you employ the use of external chest compression with sandbags in the management of patients with severe ARDS who are not candidates for proning?

When would you consider biopsy for an incidentally noted, PET negative, solid, solitary pulmonary nodule that is >8mm in size?

Is there a role for antifibrotic therapy in post COVID-19 pulmonary fibrosis?

Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?

What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

What is your approach to treatment for a patient with progressive ILD (UIP pattern) with high titer RF but no articular symptoms?

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?

Would you offer adjuvant chemotherapy, osimertinib, or both to a patient with Stage IB EGFR mutated lung adenocarcinoma found in the lung explant pathology after bilateral lung transplant?

Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?

How do you treat multisystem sarcoidosis refractory to methotrexate, humira, and remicade?

What strategies can be employed to manage interstitial lung disease seen with trastuzumab deruxtecan?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use? Do you feel the dosing used in...

How would you approach treatment for fulminant RA-associated ILD?

Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...

What are your recommendations regarding methotrexate usage in patients with persistent chest CT changes post COVID pneumonia?

Would you have a different opinion based on whether it is a new therapy or an existing and previously well-tolerated therapy for the patient?

How do you evaluate a suspicious, but negative pleural effusion when working up NSCLC and SCLC?

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

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

Does this add any value?

What criteria do you use on echocardiogram and PFT to determine who needs further evaluation for CTD-associated pulmonary hypertension?

What indicators do you use to identify patients with CTD-ILD who do not have potential to improve from continued immunosuppressive therapy?

Do you use imaging (fibrosis vs. pneumonitis), PFTs, duration of prior immunosuppressive therapy?

What is your preferred regimen for remission induction and maintenance in EGPA with cardiac involvement?

How do you approach patients with ANCA vasculitis who had partial response, but continue to have disease activity on q 6 month maintenance rituximab and remain on steroids?

Would you change rituximab maintenance dose or schedule?

How do you choose between oral and IV cyclophosphamide for the treatment of ANCA-associated vasculitis?

What is your approach for a symptomatic inpatient with locally advanced NSCLC who cannot have a PET?

Would you consider treating the full mediastinum or any mildly enlarged nodes, even contralateral? Do you have a strategy that transitions from a pall...

What immunosuppressive agents aside from steroids would you use to treat bronchiolitis obliterans in a patient with long-standing seropositive RA?

How do you approach the management of SSc-ILD in a patient on immune checkpoint therapy?

Would you use inhaled steroids with or without oral steroids for the treatment of radiation pneumonitis?

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering? If s, for what pneumonitis grade? What specific steroid...

How do you treat an AAV patient with recurrent bronchial stenosis that has not responded to rituximab induction therapy and dilatations?

Are there any concerns about using nintedanib in a patient with progressive fibrosing ILD on background mycophenolate?

Is positive pleural fluid cytology from pleural mesothelioma considered M+?

Should patient be considered for definitive therapy or chemo alone if pleural cytology positive but no T4, N2, or sarcomatoid features?

How do you treat CTD-associated organizing pneumonia?

How is your approach to treatment different than other ILD patterns such as NSIP? Does treatment response vary based on underlying CTD?

How will you use tocilizumab in the treatment algorithm for SSc-ILD, given its recent FDA approval?

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

How do you manage end-organ toxicity such as hepatotoxicity or pulmonary toxicity in a patient receiving RET-inhibitors for NSCLC?

What is your approach to treatment for MDA5 dermatomyositis patients with rapidly progressive ILD?

Cyclophosphamide/tacrolimus and Rituximab have been used in conjunction with steroids in case series.

Is there a role for anti-IL6 therapy in SSc-associated ILD?

Are there AAV patients for whom you would consider combination therapy with cyclophosphamide and rituximab?

Can liquid biopsy be substituted for tissue biopsy in a lung mass that is radiologically suspicious for primary lung cancer when CT-guided biopsy cannot be done?

For example, a patient with a large (>3cm), spiculated, FDG-avid lung lesion, who has poor lung function and is refusing a CT-guided biopsy?

What is considered an adequate treatment period to assess response of AAV induction therapy with rituximab or cyclophosphamide?

Which EGPA patients are most likely to benefit from treatment with anti-IL-5 agents such as mepolizumab?

What steroid sparing agent do you use for treatment of cardiac sarcoidosis?

Does the type of cardiac involvement impact this choice?

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

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

What is the optimal management of patients with stage II lung cancer without nodal metastasis, but unresectable due to poor pulmonary reserve?

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

Do you consider cystic fibrosis a contraindication to lung SBRT for primary NSCLC or oligometastases?

How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

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?

Which ANCA vasculitis patients are better candidates for cyclophosphamide rather than rituximab?

How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?

Are there certain subsets of ANCA vasculitis patients for whom you would consider life long maintenance therapy?

When a patient presents with 2 lung lesions, do you routinely recommend a biopsy of both lung lesions?

Would your practice change if the patient had N2 disease?

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?

What clinical factors do you use to determine timing of on-demand dosing of rituximab in ANCA vasculitis maintenance therapy?

Do you recommend on-demand versus fixed-schedule dosing for rituximab maintenance in ANCA vasculitis?

If you use both, how do you decide which to use for a particular patient?

What is the role of nintedanib in the treatment of SSc-ILD?

The SENSCIS trial was published in 2019 on efficacy of this agent. However, it's not clear where this should be in the treatment algorithm: Monot...

When do you use tacrolimus in patients with myositis-related interstitial lung disease?

How do you manage early and symptomatic fibrosis in lung cancer patients after RT?

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumon...

What agent do you try next in patients with myositis-related interstitial lung disease who are refractory to mycophenolate mofetil and azathioprine?

When do you stop immunosuppressants in patients with GPA?

What is your next step in patients with polymyositis without interstitial lung disease who are refractory to methotrexate?

Is there an increased risk of pneumonitis in COVID-19+ patients receiving lung irradiation?

Any differences in the risks between SBRT vs. conventionally fractionation? Concurrent immunotherapy?

How do you treat extensive stage small cell lung cancer in the very elderly (more than 80 yrs)?

Do you use an age limit cutoff for SBRT in lung cancer?

Is there a certain age beyond which it is not safe to do SBRT?

How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?

Should staging and treatment decisions be made based on imaging alone?

How would you treat a patient with extensive-stage small cell carcinoma and severe end-stage COPD on home oxygen?

Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?

In a patient with ILD and metastatic NSCLC with positive PD-L1, would you give chemo/pembrolizumab, chemotherapy alone, or pembrolizumab alone?

Does the degree of PD-L1 expression weigh into your decision?

How do you approach elderly patients with stage III NSCLC who have a reasonable performance status?

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?

Is IO related pneumonitis in the radiation field or more diffuse?

What is your approach for a primary tracheal squamous cell carcinoma?

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Should patients with idiopathic pulmonary fibrosis be placed on nintedanib or pirfenidone before starting radiotherapy for lung cancer?

How important is a severely diminished diffusion capacity in determining whether to offer a lung cancer patient radiotherapy?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

How would you manage palliation in a patient with postobstructive pneumonia caused by a mediastinal mass?

Would you treat if there is active infection? How much improvement would you expect?

How are you using liquid biopsy in the routine management of your patients with metastatic NSCLC?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

How do you approach the workup of subcentimeter contralateral nodules in cases of locally advanced NSCLC?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

What factors do you consider to help guide treatment for patients with high grade large cell neuroendocrine cancers of the lung?

Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...

How do you manage an adult primary rhabdomyosarcoma of the lung/mediastinum?

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

Do you consider idiopathic pulmonary fibrosis a contraindication to lung SBRT?

There are varying reports in the literature which seem to suggest increased rates of Gr 4-5 pneumonitis in IPF patients. How do you manage these...

Do you use anti-PD-1/anti-PD-L1 therapies in lung cancer patients with a prior history of radiation pneumonitis?

What about patients who are still on steroids for radiation pneumonitis?

When is it considered inappropriate to omit pathological mediastinal lymph node staging for non-small cell lung cancer?

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < ...

When do you start steroids for radiation pneumonitis?

Following lung RT, I have rarely seen patients present with pneumonia-like symptoms of radiation pneumonitis. I'm more likely to see a patient with wo...

How do you approach lung tumors with vessel encasement, especially in someone with active hemoptysis?

Is there any concern about hemorrhage from treatment effect on tumor? Would SABR worsen the chance of fatal hemorrhage/hemoptysis and if so, would you...

What are your criteria for treating a patient with lung SBRT in the absence of a biopsy?

Roughly what percentage of patients are treated without a biopsy?

If a PET/CT scan is positive for mediastinal lymph node involvement, is a mediastinoscopy or EBUS still required for NSCLC staging?

In practice, do you send patients with N2/3 disease for mediastinal staging if not offered upfront?