Pulmonology

Inhaler nonadherence and social determinants of health

Policy
February 26, 2022

Cities and urban environments tend to have large gaps in health care accessibility and correspondent health care disparities. Despite the existence of localized public health infrastructure, such infrastructure tends to be fragmented and cannot fully encompass the level of nuance within its patient population as a result. As such, health care inequities are cyclically perpetuated in part through discontinuous health systems. Smarter, patient-centric approaches are needed to move the needle …

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How Prior Authorization Fatigue Syndrome impedes asthma care

Physician
November 24, 2021

I’m writing this case report to raise awareness about a condition plaguing the health care system. The condition is Prior Authorization Fatigue Syndrome (PAFS). This condition is the direct result of the circuitous process of prior authorization (PA).

I am the physician owner of a medium-sized allergy practice in Southern Colorado. In our clinic, we spend many hours navigating the PA system to obtain approval for a range of health conditions. …

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When air hurts and becomes the harshest invader

Conditions
July 19, 2021

Wood art

When Air Hurts
When the Lung Repulses Air
When Air Becomes the Harshest Invader
When Air Is Heavier Than Mountains

This work was inspired by my father and many other patients who were struggling to breathe. The soft, unnoticeable air suddenly becomes a palpable matter wildly invading the walls of the respiratory system, making noises and creating resistance.

A “refreshing” breath leaves the person more tired, …

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A medical ethicist asks questions about CPAP

Conditions
April 29, 2021

About a year ago, I was referred to a sleep clinic and was diagnosed with “very mild obstructive sleep apnoea” (OSA). A continuous positive airway pressure (CPAP) device was recommended with a litany of disorders that would occur (heart disease, CVA, HTN, decreased mortality, motor vehicle accidents, etc.) if I did not use the apparatus consistently and properly.

I assiduously used it for two test periods. Though the physician reported improvement, …

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Mobilizing medicine: a breathtaking solution to asthma disparities

Policy
May 28, 2020

Asthma is one of the most common chronic diseases in the U.S., with a prevalence of 15.2 percent. The condition is manageable when treatment is appropriately prescribed, adjusted, and accessed by the patient. However, uncontrolled asthma can impair various facets of life and may even be fatal. This dichotomy is noteworthy, especially when considering how strongly asthma outcomes correlate with other elements of an individual’s social …

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Black boxes: health warning or profit warning?

Meds
February 1, 2020

“Boxed warnings” or “black boxes” are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks.

The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes “confuse” and “unnecessarily alarm” patients).

So it was no surprise that when the Read more…

A diagnosis of pneumonia in a rehab facility: We can do better

Physician
June 28, 2019

I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups.

He fell and broke his hip. Then he went to skilled rehab, one of a half dozen near Cityside Hospital. His stay turned longer than expected because he fell, luckily didn’t break anything, but had to go back …

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The systemic poverty in Navajo Nation is a national travesty

Physician
May 10, 2019

“I have the CPAP machine. I’ve had it for a year, but I don’t have electricity in my house. I stayed with my aunt who has electricity but things didn’t work out,” said the young Navajo man, his massive belly protruding out from underneath the tray table.

The old Navajo man with Parkinson’s disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal …

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USMLE Step 1 tips that may surprise you

Education
April 21, 2019

To reach my current position as a general cardiologist, I have taken nine board exams. I have also been teaching medical students for over ten years with several colleagues who write questions for the USMLE Step 1 exam. Through this experience, I have observed a number of themes about what works and does not work for board preparation. I share these with you now in the hopes they may help …

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MKSAP: 52-year-old woman with shortness of breath

Conditions
April 6, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her …

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Wonder why your hospital is full?

Physician
February 11, 2019

Why is your hospital always full? Actually, it’s more than full.  You have twenty boarders in the ED. You turned your postop recovery unit into an overnight surge center.  Every day administrators beg you to please, please discharge patients, if possible before 11 a.m.  You’ve hired an army of case managers, dissected the discharge process, and held countless capacity management meetings, but you’re still bursting at the seams.

It wasn’t always …

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A stage IV lung cancer survivor story

Conditions
January 23, 2019

I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients.

I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.)

In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. …

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Treating sleep apnea without CPAP

Conditions
January 11, 2019

It was 4:00 a.m. when I made it to my parents’ home. My mother called me to say that my father was having a hard time breathing. I could hear him struggling in the background. I ran inside to see my mother cradling my father on the floor — not breathing. I performed CPR on the man that gave me life! CPR on the person who just three months earlier …

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Your first 24-hour shift

Physician
January 10, 2019

How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.

When I get to work, full of nervous energy, I am relieved to find out …

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MKSAP: 55-year-old man with severe COPD

Conditions
December 29, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago without much improvement in exercise capacity. He quit smoking 1 year ago. …

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Medical students: You are more than your grades

Education
June 15, 2018

Recently, I entered an essay contest on advice you would give to future medical students. I sincerely believe that the best person to write an article offering advice to younger medical students should come from a person who didn’t match. Also known as me. Why, you say? Well, for everyone else, Match Day is a culmination of four years of mentally, physically, and emotionally taxing work. They might even forget …

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A pulmonary physician’s take on vaping

Conditions
April 27, 2018

Walking down the street, I sometimes see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device …

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Learn typical community acquired pneumonia with a Medcomic

Conditions
March 26, 2018

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital or less than 48 hours after hospital admission. CAP is classified into typical and atypical subtypes, differentiated by their presentation and causative pathogens. This illustration focuses on the classic features of typical CAP.

The most common cause of typical CAP is Streptococcus pneumoniae. It is an encapsulated, gram-positive, …

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MKSAP: 75-year-old man with very severe COPD

Conditions
February 3, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He …

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CME Spotlights