Pulmonology Features Archive

Case Study: Shortness of breath in a COPD patient with obesity

Case Study: Shortness of breath in a COPD patient with obesity

A middle-aged patient with morbid obesesity and COPD complains about having shortness of breath at rest and dyspnea on exertion.

Diagnosis of hospital-acquired pneumonia still a challenge

Diagnosis of hospital-acquired pneumonia still a challenge

Clinicians must rely on the combination of clinical examination, signs and symptoms, microbiologic testing, and radiographic findings to diagnose hospital-acquired pneumonia.

Case Study in Urgent Care: Leg edema and shortness of breath

Case Study in Urgent Care: Leg edema and shortness of breath

A 44-year-old man presents to an urgent care clinic with leg edema and shortness of breath.

Using an evidence-based approach to diagnose IPF

Using an evidence-based approach to diagnose IPF

The importance of ruling out conditions other than idiopathic pulmonary fibrosis is highlighted in this case of a 62-year-old female.

A clinician and patient mistake

A clinician and patient mistake

It is well-accepted that healthcare practitioners have a duty to their patients, but do patients have a duty as well?

An unusual cause 
of respiratory distress in an infant

An unusual cause 
of respiratory distress in an infant

A congenital condition is found in an infant with respiratory and gastrointestinal symptoms.

Cryptogenic organizing pneumonia

Cryptogenic organizing pneumonia

Patients with COP generally have positive outcomes following a definitive diagnosis and the initiation of appropriate treatment.

Steroid and rescue inhalers

Steroid and rescue inhalers

A clinician offers a tip helping patients remember to use their steroid inhalers.

Monitoring for pulmonary hypertension

Monitoring for pulmonary hypertension

Doctors must assess for the presence of pulmonary hypertension in patients with lung disease, COPD, or emphysema, among other conditions.

Nivolumab versus docetaxel in patients with advanced squamous cell non-small cell lung cancer

Nivolumab versus docetaxel in patients with advanced squamous cell non-small cell lung cancer

Recent studies show that nivolumab was associated with increased overall survival rate when compared to docetaxel in patients with advanced squamous cell non-small cell lung cancer.

A perioperative approach
 for pediatric asthma

A perioperative approach
 for pediatric asthma


Pediatrics patients with asthma who have to undergo surgery are at risk for complications.

Stat Consult: Acute bronchitis

Stat Consult: Acute bronchitis

Learn how to diagnosis and treat acute bronchitis.

Busy office 
setting leads to missed diagnosis

Busy office 
setting leads to missed diagnosis

A clinician misses a fatal pulmonary embolism in a patient known to make minor complaints.

Electronic cigarettes—The primary care provider's response

Electronic cigarettes—The primary care provider's response

Although e-cigarettes may not be considered healthy, they may be the lesser of two evils when compared with traditional tobacco cigarettes.

Oxygen therapy in a patient with emphysema

Oxygen therapy in a patient with emphysema

Take caution when using oxygen therapy to treat patients with emphysema.

A mnemonic device for use in cardiology care

A mnemonic device for use in cardiology care

Use the acronyms PASS and PAID to remember important murmurs

Xylitol: Low-cost treatment for dental caries, upper respiratory infections

Xylitol: Low-cost treatment for dental caries, upper respiratory infections

Xylitol is a primary sugar alcohol that can be used to help various dental problems as well as upper respiratory and ear infections.

Diabetes control in a patient with multiple hospitalizations

Diabetes control in a patient with multiple hospitalizations

A patient with type 2 diabetes for ten years experienced three recent hospitalizations and a COPD exacerbation that required an increase in maintenance steroids.

Help smokers quit on the 'DOT'

Help smokers quit on the 'DOT'

The Department of Transportation's new physical examination requirement helps employees quit smoking.

Corticosteroid inhalers may reduce growth in kids

Corticosteroid inhalers may reduce growth in kids

Regular use of inhaled corticosteroids may cause a small reduction in height or a dose-dependent reduction in growth velocity.

N-acetylcysteine supplements boost overall health

N-acetylcysteine supplements boost overall health

The WHO indicates NAC is essential for pulmonary and renal protection, antimicrobial uses, and psychiatry.

Identifying obstructive sleep apnea

Identifying obstructive sleep apnea


Airflow disturbances during sleep need to be recognized and evaluated before harm comes to the patients themselves or those around them.

Yoga for asthma harmless but not helpful

Yoga for asthma harmless but not helpful

Study suggests yoga does not offer benefits for patients diagnosed with asthma and should be considered a supplemental alternative intervention.

Make a permanent mark on your patient's asthma treatment

Make a permanent mark on your patient's asthma treatment


I have my patients bring all of their pumps to me and will write on the plastic canister with a Sharpie permanent marker.

Magnesium for treating CVD, T2D, and asthma

Magnesium for treating CVD, T2D, and asthma

Magnesium is a common component of lightweight metals and is the fourth most abundant mineral in the body.

Encouraging patients to adopt healthier lifestyles

Encouraging patients to adopt healthier lifestyles

Disclosing his own cessation success, this veteran practitioner inspired a COPD patient to quit smoking.

Hypertonic saline effective in bronchiolitis

Hypertonic saline effective in bronchiolitis

Of the patients, 42.6% treated with normal saline required hospital admission, compared with 28.9% of the hypertonic saline group.

Azithromycin pros beat cons in pneumonia

Azithromycin pros beat cons in pneumonia

Although azithromycin is usually first-line treatment, recent evidence has linked the drug with an increased risk of cardiovascular events.

Help children keep asthma at bay

Help children keep asthma at bay

Begin to impart asthma information to young patients and/or their caregivers as early as possible.

Benzodiazepines linked with worse COPD

Benzodiazepines linked with worse COPD

New users of benzodiazepines were 45% more likely to experience an exacerbation of respiratory symptoms.

A child's cough: common presentations and causes

A child's cough: common presentations and causes

Clinicians who recognize various types of pediatric coughs will be better able to identify serious underlying conditions in the young patient.

Pump up the heart's volume

Pump up the heart's volume

Heart sounds can be difficult to hear in someone whose lungs are hyperinflated. Here's a tip to make it easier to detect.

What does a pleural rub sound like?

What does a pleural rub sound like?


A straightforward simile to help young clinicians learn what to listen for when auscultating a patient.

Blow away your pediatric patients

Blow away your pediatric patients


Tips for when you perform the respiratory portion of a pediatric examination.

Breathing difficulty despite following COPD guidelines

Breathing difficulty despite following COPD guidelines

What therapeutic options exist for COPD patients who follow guidelines but still have difficulty breathing?

Addressing decreased libido in smokers

Addressing decreased libido in smokers

What can be used to treat vaginal dryness and decreased libido in women who smoke?

An unproductive cough leads to a life-threatening diagnosis

An unproductive cough leads to a life-threatening diagnosis

An oncologist and hematologist are consulted when an otherwise healthy 19-year-old patient presents with a cough that won't go away and an enlarged left arm.

Frequency of spirometry for asthma patients

Frequency of spirometry for asthma patients

How often should stable patients with asthma undergo spirometry?

Where are the generic inhalers?

Where are the generic inhalers?

What options are available for patients who cannot or are unwilling to pay the higher copayment for nongeneric medication?

PPI ups risks without improving asthma control in kids with GER

PPI ups risks without improving asthma control in kids with GER

Lansoprazole was associated with higher rates of upper respiratory infection, sore throat and bronchitis and no effect on asthma control.

How often should asthma be assessed?

How often should asthma be assessed?

At what point is it safe to consider stopping a steroid metered-dose inhaler?

Salt therapy beneficial for respiratory conditions, psoriasis

Salt therapy beneficial for respiratory conditions, psoriasis

Warm saltwater gargles for sore throats and salt poultices for soft-tissue infections are two of many commonly used salt therapies.

Intermittent budesonide as effective as daily Tx for asthma

Intermittent budesonide as effective as daily Tx for asthma

Budesonide given only during acute respiratory illness may prevent asthma as effectively as daily budesonide in young children with a history of wheezing.

Recurring GI symptoms following winter fever and cough

Recurring GI symptoms following winter fever and cough

A young man presents with constant periumbilical pain, extreme weakness, anorexia, nausea, constipation, and orthostasis.

Managing infants with bronchiolitis

Managing infants with bronchiolitis

The symptoms of this common lung infection usually dissipate after a week, but some cases can become severe and require hospitalization.

Avoid vitamin A supplementation in smokers

Avoid vitamin A supplementation in smokers

Individuals who smoke or have ever smoked should avoid high-dose vitamin A supplementation due to a high correlation between smoking, vitamin A and lung cancer.

Decreasing secretions following tracheostomy

A patient with a tracheostomy for severe obstructive sleep apnea has not responded to several treatments to decrease secretions from the plastic tube. What's the next step?

Physical activity interventions help teens quit smoking

The addition of a pedometer-based physical activity intervention to a smoking cessation program increased quit rates in teenagers, particularly in boys.

Noninvasive ventilation reduces mortality, intubation in respiratory failure

A recent randomized trial evaluated the effects of noninvasive ventilation on mortality and need for intubation in elderly patients with hypercapnic respiratory failure.

Could this be COPD?

A Native American man aged 40 years presents with a very tender right rib cage cystic formation that measures 2.0 x 2.0 x 0.5 cm.

Ice down dyspnea

A nurse offers a surprising, yet effective solution for helping patients catch their breath.

Do PPIs affect calcium absorption?

Are there any studies that confirm effective calcium absorption when the patient is taking long-term proton pump inhibitors (PPIs) along with oral calcium?

Prophylactic azithromycin reduces COPD exacerbations in high-risk patients

A new randomized trial provides strong evidence that azithromycin reduces exacerbations and improves respiratory function in high-risk patients.

Avoiding bad auscultation techniques

Are more clinicians performing auscultation through garments?

Spray steroidal nasal spray toward the ears

Help patients avoid nose bleeds with this simple directive.

Choosing the best inflammation marker

Which serologic measure of inflammation is the most cost-effective and reliable when monitoring inflammatory disease?

Effectiveness of a sinus CT

How reliable is a CT scan of the sinuses in a patient who does not respond to an initial extended course of antimicrobial treatment for sinusitis?

Managing pediatric asthma

Managing pediatric asthma

Asthma can disrupt sleep, resulting in missed school days, and may affect a child's ability to participate in sports and other activities. Remember that asthma symptoms in children and adults may differ.

Improvised medication spacer

A nurse practitioner shares instructions for making an asthma medication spacer to use in emergency situations out of every day materials.

What caused this nail dystrophy?

Could a woman's nail dystrophy be related to a history of mild intermittent asthma?

Quercetin may be a useful complementary therapy for conditions involving oxidative damage

Quercetin may be a useful complementary therapy for conditions involving oxidative damage

Quercetin, a potent antioxidant, is found in red wine, onions, green tea, apples, berries and cruciferous vegetables and is a popular component in the herbal and supplemental marketplace due to it's value in treating and preventing many illnesses.

Cardioprotection in a complex patient

What is the best choice for cardioprotection in a woman aged 75 years with episodic symptomatic angina, MI one year earlier and a sensitivity to nitroglycerin patches and spray?

Are high-dose beta blockers safe for patients with pulmonary disease

Is it safe for a patient with chronic obstructive pulmonary disease to be on high doses (e.g., 100 mg b.i.d.) of metoprolol?

Depression treatment in an overweight recent ex-smoker

Which antidepressant would you recommend for a woman aged 47 years who presents with depressed mood, low energy, decreased motivation and hypersomnia?

Breathing tips for patients with COPD

A nurse uses two easy-to-remember catch phrases to encourage pursed-lip breathing among patients with COPD.

Tonsillopharyngitis vs. peritonsillar abscess

What is the best way to differentiate tonsillopharyngitis from a peritonsillar abscess?

Moving beyond "Just say no"

Moving beyond "Just say no"

Discourage teenagers from engaging in risky behaviors such as drug, tobacco and alcohol use in a meaningful way.

Tips for treating elevated homocysteine levels

What are the consequences of elevated homocysteine in young asymptomatic patients with and without comorbidities?

Brewer's yeast: Medical uses in cancer, therapy for premenstrual syndrome and antibiotic-associated diarrhea

Brewer's yeast: Medical uses in cancer, therapy for premenstrual syndrome and antibiotic-associated diarrhea

Brewer's yeast, or Saccharomyces cerevisiae, is specifically grown as a nutritional substance rich in chromium, selenium, proteins and B-complex vitamins.

Latent tuberculosis in a patient vaccinated with BCG?

Are health care providers performing proper follow-up for patients who where previously diagnosed with BCG vaccine who have positive skin tests for tuberculosis?

Sertraline in patients with pulmonary disease

Is sertraline contraindicated in patients with asthma or chronic obstructive pulmonary disease (COPD)?

Nasal spray to reduce skin irritation

Clinician shares an unexpected dermatologic use for fluticasone.

Sneaky tonsil swab

Tip for guaranteeing a culture the first time you swab.

The best therapies for bacterial rhinosinusitis

The best therapies for bacterial rhinosinusitis

Knowing when to prescribe antibiotics and what kind to give is crucial. Here are some guidelines for patients with mild-to-moderate infections.

Licorice

Licorice

Medically, licorice traditionally has been used as a general anti-inflammatory, antitussive, GI soothant, and for respiratory support. The potential for antiviral activity and hepatocellular protection in cases of hepatitis C has also been discussed.

When is it appropriate to order abdominal ultrasound?

Clinician seeks guidelines for ordering abdominal ultrasound to detect asymptomatic abdominal aortic aneurysm in a smoker.

Antibiotics may benefit some patients with acute otitis media

Amoxicillin-clavulanate studied in children who met strict criteria for AOM diagnose.

Slaying the gag reflex

A tip for performing rapid strep tests and throat cultures.

When to swab for pertussis

When should an adult with a spasmodic upper-respiratory infection be swabbed for pertussis?

How effective is BCG vaccine against TB?

Given the number of immigrants from Third World countries, why are medical providers still teaching that BCG vaccine provides lifelong protection against TB?

Pneumonia leads to organ failure

Pneumonia leads to organ failure

Should the clinicians be held responsible for failing to offer revaccination to a high-risk patient?

Woman's coughing fit leads to psychotic episode

Hospital staff surprised by a patient's sudden change in disposition.

Nurse trusts instincts, diagnoses colleague's potentially life-threatening condition

Early experience in the medical ICU helped a nurse choose the appropriate test.

Physician assistant helps make ill veteran's dream come true

Physician assistant helps make ill veteran's dream come true

A quick email resulted in an outpouring of appreciation for a veteran's service.

PCPs can treat COPD without referral

PCPs can treat COPD without referral

Treatment with a combination of long-acting bronchodilators and inhaled glucocorticosteroids can reduce the rate of decline in lung function.

Throat pain causes a patient to divulge his lifelong secret

Throat pain causes a patient to divulge his lifelong secret

The man's heretofore unknown neurologic condition calls the original diagnosis into question.

Eardrum safety

Do decongestants and/or antihistamines decrease the likelihood of tympanic membrane (TM) rupture?

Oral corticosteriods as effective as IV formulations for patients with COPD

High-dose IV corticosteroids are widely prescribed for patients admitted to the hospital with acute exacerbation of chronic obstructive pulmonary disease (COPD), despite guidelines recommending oral steroids at lower doses.

Clearing for duty after PPD conversion

Clearing for duty after PPD conversion

When x-rays are not available, should asymptomatic employees be allowed to return to work?

An effective natural remedy for migraine and allergies

An effective natural remedy for migraine and allergies

Butterbur, once discouraged because of its potential to cause liver damage, is now widely used in Europe to combat allergic rhinitis, asthma, and migraine.

Does smoking after treatment for opioid addiction lead to relapse?

Does tobacco use after buprenorphine and naloxone (Suboxone) treatment encourage relapse?

Repeating the tuberculin skin test in an older patient

What risks are involved?

Are electronic cigarettes safe?

Are e-cigarettes a better alternative to smoking?

Blue fingers linked with breathlessness

A physically fit young woman seeks medical care when she develops increasing dyspnea and signs of a circulatory disorder.

Asthma in adulthood: different and complex

Childhood asthma tends to be allergic, whereas adult forms comprise airway disorders. Our experts tell how to classify, treat, and manage the condition.

When to suspect lung cancer, and what to do

When to suspect lung cancer, and what to do

If a patient smokes and reports a cough and weight loss, don't take any chances: Order an x-ray. And there are other symptoms to watch for, too.

When bronchitis takes a turn for the worse

A change in cough, sputum, or dyspnea can signal an acute exacerbation. Here's what you can do to help keep the situation under control.

Pulmonary disease masquerading as lung cancer

The pathologist identified the enlarging nodule as "undifferentiated malignancy," but the author insisted on a repeat biopsy.

Lung cancer mistaken as influenza

Relying only on her notes, a clinician was able to explain why a chest x-ray was not ordered sooner.

Misdiagnosis of smoker's chest pain

The patient seemed to have GERD and responded to treatment. But then he had a fatal heart attack.

Sign Up for Free e-newsletters