Pulmonology

Pulmonologists and physicians writing on KevinMD about the lungs: asthma and inhaler technique, COPD, sleep and insomnia, tobacco harm reduction, ventilator care after discharge, lung cancer, and the pandemic as it was lived on the respiratory wards. Board-review cases make up part of this archive. One maintained record draws on this archive: COVID-19: what physicians wrote as it happened.

Medical treatment has its limits. Empathy does not.

Caroline Tredway, MD

Physician

August 29, 2015

“This is our sickest patient,” my co-intern began as she told me about one of her patients I would care for overnight. It was my first week of intern year, and I was assigned the overnight cross-cover shift for a busy cardiology service. Introducing myself as “Dr. Tredway” still rolled awkwardly off my tongue, but I had grown more comfortable throughout the week in my new role as a physician. …

Test your medicine knowledge: 72-year-old woman with COPD

mksap

Conditions and Diseases

June 27, 2015

shutterstock_248807428

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

A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to …

Paying people to quit smoking. Does it work?

Albert Fuchs, MD

Conditions and Diseases

June 17, 2015

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Smoking is a major cause of heart attacks, strokes, emphysema, and lung cancer. Smoking rates have steadily declined in the U.S. in the last 50 years, but about a fifth of U.S. adults still smoke. Helping them quit would make a major contribution to their health.

A study in the New England Journal of Medicine (NEJM) studied the effectiveness of different …

A rare case in a rural doctor’s office

Hans Duvefelt, MD

Conditions and Diseases

May 2, 2015

I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath.

He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he …

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A rare case in a rural doctor’s office

Don’t use essential oils for asthma. Here’s why.

Chad Hayes, MD

Medications

April 22, 2015

Alright, we need to talk. Those of you who follow my blog know that I don’t shy away from controversial topics and that I don’t have a problem speaking my mind. I try to do it in a respectful, informative, and somewhat humorous way. But I saw something this morning that needs to be addressed, and it’s not funny at all.

As I was eating breakfast before work, I saw a …

Television ruins your sleep. Here are 5 ways how.

Deep Ramachandran, MD

Conditions and Diseases

March 24, 2015

As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of …

Help patients make better decisions about lung cancer screening

Michael J. Barry, MD

Conditions and Diseases

February 26, 2015

The high cost of health care in the United States in part relates to how clinicians are paid. Performing expensive and often risky procedures simply pays better than engaging patients in a shared decision-making conversation. Shared decision-making (SDM) is a process where clinicians and patients educate each other about treatment options, risks and benefits, and preferences, and then they decide on the best approach together. Patient decision aids can assist …

5 tips for travelling with your CPAP

Deep Ramachandran, MD

Conditions and Diseases

February 22, 2015

Sleep apnea is a condition that afflicts millions of people. There are two types of sleep apnea: central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about sleep apnea. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, …

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5 tips for travelling with your CPAP

MKSAP: 72-year-old man with dyspnea at rest

mksap

Conditions and Diseases

February 7, 2015

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

A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased …

Analyzing the new treatment recommendations for bronchiolitis

Christopher Johnson, MD

Conditions and Diseases

December 9, 2014

Every fall I write about bronchiolitis because it is one of the most common respiratory ailments affecting infants and children under about two years of age. It is the most common reason infants end up in the hospital during the winter and early spring months. Every year we get severe cases in the PICU. Pediatricians have struggled for decades to figure out how to treat bronchiolitis but we don’t have …

Lung cancer screening and shared decision making: Will it happen?

Kenneth Lin, MD

Conditions and Diseases

December 4, 2014

Recently, the Centers for Medicare & Medicaid Services (CMS) officially proposed coverage for annual low-dose computed tomography (LDCT) screening for lung cancer in current or former smokers age 55 to 74 years with at least a 30 pack-year history. In doing so, CMS followed the lead of the U.S. Preventive Services Task Force, which had previously given a “B” grade recommendation for screening in a similar population through age 80 years.

In the …

No CT scans for old smokers?

Dr. Saurabh Jha

Conditions and Diseases

November 6, 2014

“Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a ‘check-up,’ or ‘screening,’ when their computerized records show they are ‘due.’ Non-attendance is known as ‘non-compliance,’ indicating an element of recklessness and irresponsibility.”

– Petr …

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No CT scans for old smokers?

MKSAP: 72-year-old woman with severe COPD

mksap

Conditions and Diseases

November 1, 2014

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

How to talk to a patient with terminal cancer? Not like this.

Allen Frances, MD

Physician

October 6, 2014

A friend of mine has been living well with lung cancer for five years — working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute.

Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, …

A new drug to treat RSV bronchiolitis

Christopher Johnson, MD

Medications

October 1, 2014

Respiratory syncytial virus infection, aka RSV, is a common infection in children. A key aspect of RSV is how poor a job our immune systems do in fighting it off. Virtually all children are infected with RSV during the first few years of life. Not only that, all of us are reinfected multiple times during our lives. Attempts at devising a vaccine for RSV have all been unsuccessful. In fact, …

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A new drug to treat RSV bronchiolitis

The quixotic quest for precision in medicine

Dr. Saurabh Jha

Physician

September 21, 2014

88.2% of all statistics are made up on the spot.
– Victor Reeves

There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything. It no longer suffices to say, “You’re at moderate risk for pulmonary embolism (PE).”

We must quantify our qualification.

Either by an interval: “Your chances of PE are between 15 and 45%.”

Or, preferably, a point estimate: “You have a 15% chance …

Inhaled medications: Nefarious reasons for the lack of competition

John F. Hunt, MD

Medications

August 29, 2014

Check out the prices for nebulizer solutions of albuterol and budesonide (generic Pulmicort). They are totally affordable. $4 for a month for albuterol. $14 for a month for budesonide respules. Pulmicort respules used to be very expensive. Now even the branded budesonide is less than 10% of a monthly cable bill.

Then check out the prices of inhaled steroids delivered through meter dose inhaler (MDI) or dry powder inhaler (DPI). These …

Sleep apnea in children: A primer from a pediatric intensivist

Christopher Johnson, MD

Conditions and Diseases

August 26, 2014

Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had …

A rational approach to CT lung cancer screening

Kenneth Lin, MD

Conditions and Diseases

July 7, 2014

Recently, a family physician colleague asked me to explain why the Affordable Care Act requires private health insurers to provide first-dollar coverage for preventive services that the U.S. Preventive Services Task Force assigns an “A” or “B” (recommended) rating, but allows public insurers (Medicare and Medicaid) to determine if and how they will cover these services.

Until recently, the question hadn’t come up, since Medicare has agreed to cover pretty much every …

MKSAP: 38-year-old man with a 1-year history of cough

mksap

Conditions and Diseases

July 5, 2014

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

A 38-year-old man is evaluated for a 1-year history of cough with mucoid sputum and a 6-month history of mildly progressive dyspnea. He has a 12-pack-year history of smoking. He has no history of asthma, allergies, skin disease, or liver disease.

On physical examination, vital signs are normal. Pulmonary examination discloses decreased breath …