Pulmonary & Chest Medicine
Vishesh Paul M.D. discusses pulmonary & chest medicine at The Carle Foundation Hospital. He speaks about proning in COVID patients. He gives us an update in asthma management and he shares the latest in pulmonary procedures such as endobronchial ultrasound.
Featuring:
Vishesh Paul, MD
Vishesh Paul, MD is a Critical Care Medicine, Pleural Disease Physician.
Transcription:
Melanie Cole: (Host) Expert insights is an ongoing medical education podcast. The Carle division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode's post-test.
Another edition of our integrated system podcast series, helping us to achieve world-class accessible care and to improve the health of the people we serve. This is Expert Insights. Here's Melanie Cole.
Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole. Today we're discussing pulmonary and chest medicine. Joining me is Dr. Vishesh Paul. He's a pulmonary and ICU physician at the Carle Foundation Hospital. Dr. Paul, it's a pleasure to have you with us.
I'd like to start with proning. We're hearing more about it for treatment for COVID patients. How is it helpful? And specifically, in regards to COVID patients, what does it mean?
Dr. Vishesh Paul: Good morning, Melanie. Thank you for having me here. So proning means when you lie down on your belly, it's technically tummy time for adults and it opens up the lungs better.
And, it allows more air to go inside the lungs and the oxygen numbers tend to go up for most patients. It has been used a lot for patients with respiratory failure in the past. But now with COVID, it is picking up for patients who are admitted on the floors who are requiring oxygen and innovate. It prevents their worsening like a person who's sick.
If you broaden them, there's a chance that their oxygen numbers may go up. And they won't worsen and they won't end up requiring ICU admission. We are seeing good benefits of it. If it's used in correctly selected patients.
Host: That is so interesting, Dr. Paul, and is this position flat? Proning is head down lower than the body or up on the body. Just explain the position just a little bit more.
Dr. Vishesh Paul: Just like the tummy time, or I'll explain, like some people sleep on their belly, just like that. We asked the people to sleep on their belly. They can have their head on either side. And usually we keep the head slightly higher so that the food and the acid doesn't come up. But apart from that, it's just like somebody sleeping on their belly.
Host: Thank you so much for that description. And it's so informative for so many people. Now let's talk a little bit about asthma management, give us a little update and some latest information and treatment modalities
Dr. Vishesh Paul: As for management, yes. In last couple of years, there have been some very significant changes, as probably everybody knows. Albuterol is a very common inhaler used in asthma and it for people with mild asthma, that's the only medicine. But now all the global organizations, they say that albuterol alone should not be used for asthma management. People with asthma, mild or moderate, they should be using steroids, inhaled steroids.
And when you do that, people have less exacerbations. They go to the ER less often. They get hospitalized less often. So that has been a big change in last two years. Another change that came with asthma was a drug called Singulair or Montelukast that is used for allergic symptoms there's a black box warning now that they can be a lot of mood disorders with it. Hence, just the use has to be done with a lot of caution.
Host: Wow. Again, so interesting. Dr. Paul. So as far as COVID-19, and we're talking about asthma, are these patients at a higher risk of serious complications and how are you approaching your patients and informing them about those risks? What would you like other providers who are working with asthma patients to know about those COVID risks?
Dr. Vishesh Paul: Yeah, that's really interesting. This whole world situation is constantly evolving so more and more studies come out. CDC currently states that patients with moderate and severe asthma could be at a greater risk. And there was a study that came out this month itself from Harvard that people with nonallergic asthma, they can have higher risk of COVID.
So we are informing the patients. Yes, if you have symptoms, get checked early, but do not stop your treatment. Some people have been worried that, Oh, if I take my regular inhaled steroids, I haven't least chances of getting COVID. No. Continuing your treatment as planned or as suggested by a doctor. Have an asthma action plan.
If you are worse contact your doctor, they'll get you the appropriate therapy. And the only thing we suggest is get checked sooner if you're having any symptoms.
Host: Well, thank you for that, you know, for making that very clear. So now let's talk about an interesting procedure, endobronchial ultrasound EBUS. Tell us a little bit about the use of it and why it's being used.
Dr. Vishesh Paul: EBUS. EBUS is endobronchial ultrasound, as you said. It's a minimally invasive technique. We do it. Why a bronchoscopy? And we can biopsy the lymph nodes inside the chest, and we can use it to diagnose cancer. Usually lung cancer, some infections like histoplasma fungal infections, which are very common in Midwest United States. And some conditions like sarcoidosis.
In the past, a surgeon had to open the chest with an incision to biopsy these lymph nodes, but EBUS has it revolutionized that, and it doesn't require any opening up. It's a 30 minute to one hour procedure. And with very good success rates.
Host: Well then what's the difference between a bronchoscopy and EBUS.
Dr. Vishesh Paul: Bronchoscopy is putting the scope or endoscope inside the windpipe. EBUS is part of bronchoscopy. You have an ultrasound at top of the bronchoscopy, which allows you to see the lymph nodes alone across the walls of the airway. Once you see these lymph nodes, you can biopsy them. And come up with the diagnosis.
Host: Isn't that fascinating? So you mentioned that because it's minimally invasive, but speak a little bit more about the benefits. How fast do you get results? Is it, is it immediate? Tell us about the benefits, not only to the patient, but to the surgeon doing the investigation.
Dr. Vishesh Paul: So we have a pathology team that works with us.
So when we get the sample, they usually are in the room and they can give a preliminary diagnosis right there. Quite often, the final diagnosis comes back in two to three days, and patient is on their way without any surgical approach without cutting open. So it's a benefit for the patient and the physician being booked.
Host: Wow. Isn't that interesting? And it's an exciting time to be in your field, Dr. Paul. What's on the horizon? What are some of the latest and most exciting things going on in the field of pulmonary medicine? Right now?
Dr. Vishesh Paul: There's plenty going on. Starting with these parliamentary procedures, VR, getting navigation bronchoscopy.
Which are again, minimally invasive techniques to biopsy and diagnose lung cancer. And sometimes you can even treat early stages lung cancer with that one procedure. Second is the injections, the biological therapy that's coming for asthma. For years, patients used to be on steroids for asthma.
If the asthma was uncontrolled and there would be a lot of unwanted side effects. But now with these shots that people can give themselves once a month or even once in two months. Their asthma's so well controlled, they can live and breathe much better.
Host: Is there anything you'd like other providers to take forward from this episode about pulmonary medicine and ICU during this pandemic, some of the new and latest procedures. Summarize it for us, Dr. Paul, and tell other providers what you would like them to know about pulmonary and chest medicine at the Carle Foundation Hospital.
Dr. Vishesh Paul: Absolutely two highlights I would say. First, encourage proning in patients who are admitted with COVID pneumonia.
It may prevent worsening of your patient and may prevent ICU transfer. They may recover faster. Second is asthma. Treat as you are. Normally don't change the treatment because of COVID. But we have newer therapies now, which can help control severe asthma patients who have been struggling for many months to years.
These shots, which patients can give are very comfortable and can make a big difference in their daily lives.
Host: It's great information, Dr. Paul, thank you so much for coming on and sharing your incredible expertise on this topic. That concludes this episode of Expert Insights with the Carle Foundation Hospital.
For a listing of Carle providers interview, Carle sponsored educational activities, please visit our website at carleconnect.com for more information, and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. And if you found this podcast informative, please share on your social channels and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.
Melanie Cole: (Host) Expert insights is an ongoing medical education podcast. The Carle division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode's post-test.
Another edition of our integrated system podcast series, helping us to achieve world-class accessible care and to improve the health of the people we serve. This is Expert Insights. Here's Melanie Cole.
Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole. Today we're discussing pulmonary and chest medicine. Joining me is Dr. Vishesh Paul. He's a pulmonary and ICU physician at the Carle Foundation Hospital. Dr. Paul, it's a pleasure to have you with us.
I'd like to start with proning. We're hearing more about it for treatment for COVID patients. How is it helpful? And specifically, in regards to COVID patients, what does it mean?
Dr. Vishesh Paul: Good morning, Melanie. Thank you for having me here. So proning means when you lie down on your belly, it's technically tummy time for adults and it opens up the lungs better.
And, it allows more air to go inside the lungs and the oxygen numbers tend to go up for most patients. It has been used a lot for patients with respiratory failure in the past. But now with COVID, it is picking up for patients who are admitted on the floors who are requiring oxygen and innovate. It prevents their worsening like a person who's sick.
If you broaden them, there's a chance that their oxygen numbers may go up. And they won't worsen and they won't end up requiring ICU admission. We are seeing good benefits of it. If it's used in correctly selected patients.
Host: That is so interesting, Dr. Paul, and is this position flat? Proning is head down lower than the body or up on the body. Just explain the position just a little bit more.
Dr. Vishesh Paul: Just like the tummy time, or I'll explain, like some people sleep on their belly, just like that. We asked the people to sleep on their belly. They can have their head on either side. And usually we keep the head slightly higher so that the food and the acid doesn't come up. But apart from that, it's just like somebody sleeping on their belly.
Host: Thank you so much for that description. And it's so informative for so many people. Now let's talk a little bit about asthma management, give us a little update and some latest information and treatment modalities
Dr. Vishesh Paul: As for management, yes. In last couple of years, there have been some very significant changes, as probably everybody knows. Albuterol is a very common inhaler used in asthma and it for people with mild asthma, that's the only medicine. But now all the global organizations, they say that albuterol alone should not be used for asthma management. People with asthma, mild or moderate, they should be using steroids, inhaled steroids.
And when you do that, people have less exacerbations. They go to the ER less often. They get hospitalized less often. So that has been a big change in last two years. Another change that came with asthma was a drug called Singulair or Montelukast that is used for allergic symptoms there's a black box warning now that they can be a lot of mood disorders with it. Hence, just the use has to be done with a lot of caution.
Host: Wow. Again, so interesting. Dr. Paul. So as far as COVID-19, and we're talking about asthma, are these patients at a higher risk of serious complications and how are you approaching your patients and informing them about those risks? What would you like other providers who are working with asthma patients to know about those COVID risks?
Dr. Vishesh Paul: Yeah, that's really interesting. This whole world situation is constantly evolving so more and more studies come out. CDC currently states that patients with moderate and severe asthma could be at a greater risk. And there was a study that came out this month itself from Harvard that people with nonallergic asthma, they can have higher risk of COVID.
So we are informing the patients. Yes, if you have symptoms, get checked early, but do not stop your treatment. Some people have been worried that, Oh, if I take my regular inhaled steroids, I haven't least chances of getting COVID. No. Continuing your treatment as planned or as suggested by a doctor. Have an asthma action plan.
If you are worse contact your doctor, they'll get you the appropriate therapy. And the only thing we suggest is get checked sooner if you're having any symptoms.
Host: Well, thank you for that, you know, for making that very clear. So now let's talk about an interesting procedure, endobronchial ultrasound EBUS. Tell us a little bit about the use of it and why it's being used.
Dr. Vishesh Paul: EBUS. EBUS is endobronchial ultrasound, as you said. It's a minimally invasive technique. We do it. Why a bronchoscopy? And we can biopsy the lymph nodes inside the chest, and we can use it to diagnose cancer. Usually lung cancer, some infections like histoplasma fungal infections, which are very common in Midwest United States. And some conditions like sarcoidosis.
In the past, a surgeon had to open the chest with an incision to biopsy these lymph nodes, but EBUS has it revolutionized that, and it doesn't require any opening up. It's a 30 minute to one hour procedure. And with very good success rates.
Host: Well then what's the difference between a bronchoscopy and EBUS.
Dr. Vishesh Paul: Bronchoscopy is putting the scope or endoscope inside the windpipe. EBUS is part of bronchoscopy. You have an ultrasound at top of the bronchoscopy, which allows you to see the lymph nodes alone across the walls of the airway. Once you see these lymph nodes, you can biopsy them. And come up with the diagnosis.
Host: Isn't that fascinating? So you mentioned that because it's minimally invasive, but speak a little bit more about the benefits. How fast do you get results? Is it, is it immediate? Tell us about the benefits, not only to the patient, but to the surgeon doing the investigation.
Dr. Vishesh Paul: So we have a pathology team that works with us.
So when we get the sample, they usually are in the room and they can give a preliminary diagnosis right there. Quite often, the final diagnosis comes back in two to three days, and patient is on their way without any surgical approach without cutting open. So it's a benefit for the patient and the physician being booked.
Host: Wow. Isn't that interesting? And it's an exciting time to be in your field, Dr. Paul. What's on the horizon? What are some of the latest and most exciting things going on in the field of pulmonary medicine? Right now?
Dr. Vishesh Paul: There's plenty going on. Starting with these parliamentary procedures, VR, getting navigation bronchoscopy.
Which are again, minimally invasive techniques to biopsy and diagnose lung cancer. And sometimes you can even treat early stages lung cancer with that one procedure. Second is the injections, the biological therapy that's coming for asthma. For years, patients used to be on steroids for asthma.
If the asthma was uncontrolled and there would be a lot of unwanted side effects. But now with these shots that people can give themselves once a month or even once in two months. Their asthma's so well controlled, they can live and breathe much better.
Host: Is there anything you'd like other providers to take forward from this episode about pulmonary medicine and ICU during this pandemic, some of the new and latest procedures. Summarize it for us, Dr. Paul, and tell other providers what you would like them to know about pulmonary and chest medicine at the Carle Foundation Hospital.
Dr. Vishesh Paul: Absolutely two highlights I would say. First, encourage proning in patients who are admitted with COVID pneumonia.
It may prevent worsening of your patient and may prevent ICU transfer. They may recover faster. Second is asthma. Treat as you are. Normally don't change the treatment because of COVID. But we have newer therapies now, which can help control severe asthma patients who have been struggling for many months to years.
These shots, which patients can give are very comfortable and can make a big difference in their daily lives.
Host: It's great information, Dr. Paul, thank you so much for coming on and sharing your incredible expertise on this topic. That concludes this episode of Expert Insights with the Carle Foundation Hospital.
For a listing of Carle providers interview, Carle sponsored educational activities, please visit our website at carleconnect.com for more information, and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. And if you found this podcast informative, please share on your social channels and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.