Respiratory Exchange

In this episode of the Respiratory Exchange Podcast, Dr. Dan Culver, Chair of Pulmonary Medicine, hosts an engaging conversation with Dr. Sonali Sethi, president-elect of the American Association of Bronchoscopy and Interventional Pulmonology (AABIP), who shares insights into cutting-edge technologies, the global impact of the AABIP and the future of advanced diagnostic bronchoscopy. Discover how the field is advancing patient care, fostering collaboration, and driving innovation worldwide. Whether you're a healthcare provider or simply curious about respiratory medicine, this episode is packed with valuable information and inspiration. 

In this episode of the Respiratory Exchange Podcast, Dr. Dan Culver, Chair of Pulmonary Medicine, hosts an engaging conversation with Dr. Moises Auron, Professor of Medicine and Pediatrics at Cleveland Clinic. Together, they explore the hospitalists’ perspective on managing COPD exacerbations in admitted patients, emphasizing a holistic approach to care. From addressing comorbidities like sleep apnea and sarcopenia to optimizing immunizations and transitioning care post-discharge, Dr. Auron provides practical insights for healthcare providers aiming to improve patient outcomes. Tune in for actionable strategies and nuanced reflections on the evolving landscape of COPD care. 

Join Dr. Dan Culver, Chair of Pulmonary Medicine at Cleveland Clinic, as he leads an insightful discussion on the future of mechanical ventilation in this edition of "Respiratory Exchange." With expert guests Dr. Eduardo Mireles and Professor Rob Chatburn, the conversation delves into the evolution of ventilator technology, the integration of artificial intelligence and the challenges of achieving patient safety, comfort and liberation. From the complexities of current ventilator modes to visionary predictions about AI-driven respiratory systems, this episode offers a captivating look into the innovations shaping critical care medicine. Whether you're a healthcare professional or simply curious about the intersection of technology and medicine, this episode is a must-listen.

In this episode of the Respiratory Exchange podcast, Dr. Les Tolle and Dr. Kamonpun (Joy) Ussavarungsi dive deep into the complexities of lymphangioleiomyomatosis (LAM), a rare and progressive cystic lung disease primarily affecting women of childbearing age. Dr. Ussavarungsi, Director of the Rare Lung Disease Clinic at Cleveland Clinic, shares invaluable insights into LAM’s pathophysiology, diagnosis, clinical presentation and treatment options, including the transformative impact of mTOR inhibitors like sirolimus. As the field advances, she highlights ongoing research and the promising future of LAM care. Whether you're a pulmonologist, a healthcare provider or simply curious about rare lung diseases, this episode offers a comprehensive exploration of LAM and its management. 

2025 CHEST Conference Highlights  In this episode, pulmonary and critical care leaders share the most exciting takeaways from the CHEST annual meeting—where innovation and practical insights meet bedside care. Our experts discuss sessions that cover real-world strategies for managing the morbidly obese ICU patient, from fine-tuning ventilation to navigating complex drug dosing. They cover presentations that give an inside look at cutting-edge sepsis research shaping new hemodynamic guidelines. They review the growing integration of AI across pulmonary and critical care research, including groundbreaking biomarker research that could redefine precision medicine in the ICU. Beyond the science, our hosts celebrate the vibrant mentorship and collaboration that make this annual CHEST conference a hub for advancing pulmonary, critical care and sleep medicine.

This podcast delivers a high-impact, practical discussion on managing critically ill pregnant patients—an area often outside the daily comfort zone of many pulmonary and critical care physicians. From recognizing subtle red flags like mild hypertension and tachypnea to navigating the complexities of airway management in the third trimester, this episode dives into scenarios you may face in emergent situations. The discussion covers the physiologic pitfalls of intubation, aspiration risks and the value of upright airway positioning, backed by simulation-based training insights. You'll also gain a grounded perspective on the judicious use of point-of-care ultrasound in obstetric emergencies and when to defer to specialists. This episode reinforces core principles and equips you with knowledge to recognize danger early and collaborate effectively under pressure.

What makes the ATS the go-to home for clinicians, researchers and educators in pulmonary health? In this inspiring episode, the new ATS president lays out a bold vision to strengthen the society’s impact—from elevating the quality and timeliness of clinical guidelines to expanding opportunities for every member to engage, grow, and lead. Whether you're a junior investigator or a seasoned clinician, tune in to discover why ATS is more than just a conference—it's a community where your work, voice, and passion truly matter.

What if subtle CT findings you're used to skimming over could actually predict increased mortality and signal the earliest stages of fibrotic lung disease? In this episode, we dive into how interstitial lung abnormalities—once considered incidental and insignificant—are now being redefined, reclassified and closely scrutinized in light of new evidence and evolving guidelines from ATS and Fleischner. Join us as we explore the diagnostic gray zones, progression risks, radiologic pitfalls and whether AI might soon help us see clearly through the fog.

Discover how Cleveland Clinic transformed a single ultrasound machine into a cutting-edge, hospital-wide Point-of-Care Ultrasonography (POCUS) program that now performs thousands of cardiac, lung, and vascular ultrasounds annually. In this episode, Drs. Ajit Moghekar and Siddharth Dugar detail their journey from early adoption to national leadership in POCUS, including its critical role during the COVID-19 pandemic and its integration into Epic and PACS for real-time clinical decision-making. Learn how they’ve overcome barriers in training, quality assurance and workflow optimization to standardize and scale across regional ICUs. The discussion also explores advanced applications like TEE during cardiac arrest, novel diagnostics in ARDS and sepsis phenotyping, and how AI and wearable ultrasound tech are set to revolutionize critical care. If you're invested in elevating bedside care with innovative imaging, this is the podcast for you.

Chronic cough is an often-misunderstood condition that places a significant quality of life burden on patients and their loved ones. For providers, this complex condition requires more than just symptom management—it calls for expert, patient-centered evaluation. In this podcast, Dr. Rachel Taliercio and Dr. Michael Ghobrial discuss how early referral to a specialized chronic cough clinic can reduce unnecessary testing, avoid treatment delays and uncover treatable causes that are often missed. They review how thoughtful history-taking and using guideline-based diagnostics can improve outcomes. They assess promising new medication trials, and how innovations like AI-powered cough monitoring and Behavioral Cough Suppression Therapy are transforming chronic cough care.

In this episode of Respiratory Exchange, titled "Treating CTEPH: Surgery, Medication or Balloon Angioplasty?" Dr. Gustavo Heresi and Dr. Alice Goyanes discuss specialized, dedicated treatment options for chronic thromboembolic pulmonary hypertension (CTEPH), a type of pulmonary vascular disease. They review when pulmonary endarterectomy is appropriate. They also discuss treatment options for patients who are not candidates for surgery, such as those with decompensated cirrhosis or metastatic cancer. For those patients, they consider the options such as using the FDA-approved vasodilator, Riociguat, and balloon angioplasty. They also note the benefits of discussion with vascular medicine and hematology.

Dr. Amy Attaway and Dr. Dan Culver review the emerging relationship between COPD patients who have intermittent hypoxemia and an increase they have in co-morbidities and mortality. They discuss how multiple associative studies suggest that intermittent hypoxemia may impact musculature, cardiovascular and neurologic systems. Dr. Attaway and Dr. Culver also underscore the need to review studies in light of the impact of skin pigmentation on oximetry, the connection to Sarcopenia and a related shift in muscle fibers from Type 1 to Type 2.

Dr. Angel Coz reviews some of the highlights from the CHEST 2024 conference with Drs. Priya Balakrishnan and Eduardo Mireles-Cabodevila. They cover aspects of talks on pneumoconiosis and occupational lung disease, sarcoidosis medication, diffuse lung disease, ECMO, neuromuscular disease and home mechanical ventilation.  They also discuss the unexpected benefits of getting lost in the hallways with all the posters, networking at the conference and becoming involved in CHEST Networks and societies.

Delerium is an acute mental disorder associated with fluctuating changes in cognition and attention and is likely a consequence of another medical condition. In this episode, Dr. Heather Torbic discusses the incidence and types of delirium, pathogenesis and patient-specific risk factors with Dr. Abhijit Duggal. Dr. Torbic also covers bedside tools for the diagnosis of delirium and treatment options, including nonpharmacologic interventions. She stresses the need to develop a better understanding of delirium pathophysiology and to implement strategies for the prevention of delirium.

Sepsis is a leading cause of death in hospitals worldwide. In this episode Drs. Matthew Dettmer and James Morrison discuss the two major patient populations: one that comes in through the emergency department and the other that is already in the hospital. They cover the defining characteristics of these groups, the patient populations more at risk for developing sepsis, and the regulations providers must adhere to as they work to prevent sepsis deaths.

Dr. Fernanda Bonilla will discuss the health implications, the challenges and opportunities in vaccinology, and the importance of collaboration in healthcare worldwide.

In this episode, we will explore the impact of RSV on transplant and immunocompromised population, emphasizing the critical role of vaccination. Dr. Gonzalez and Dr. Koval will discuss the risk factors associated with RSV and outline effective prevention strategies to protect this vulnerable population.

Vaccine Hesitancy and Proposed Strategies - Dr. Tosin Goje and Dr. Aanchal Kapoor discuss vaccine hesitancy as techniques used to communicate with patients and families include empathic listening, finding trusted sources, and addressing fears and myths.

Dr. Gregory Poland explains the different aspects and limitations of immunity, such as innate, humoral, cellular, and durable immunity, and the need for booster doses and personalized vaccinology to optimize vaccine responses.

Dr. Kristen Highland speaks with Drs. Peter Mazzone and Vickram Tejwani about the recent 2024 American Thoracic Society Conference. Topics discussed include exposure-related mutations in non-smokers' lungs, doing better at getting the right people to be screened and new tools in development like circulating tumor DNA methylation-based tools, mutation-based tools, proteins and combinations of all these things in blood. They review the need to address disparities in access to screening, a potential new medication for COPD flares, new data on eosinophilic COPD, potentially using bronchoscopes to ablate early-stage cancer and more.

Dr. Frank Esper will discuss the impact of RSV on children. He will review the burden of RSV infection in children, the history and challenges of RSV vaccine development, and the recent breakthroughs and innovations in RSV prevention. The episode will conclude with recommendations and resources for RSV prevention and surveillance.

Measurement of lung volume is used routinely by pulmonologists and according to the Global Lung Initiative (GLI) regression, women as a population have different lung volumes than men.  Dr. Philippe Haouzi, medical director of Cleveland Clinic’s Pulmonary Function Testing Lab, discusses the lack of clear evidence for this assumption and why it’s time to re-evaluate the inclusion of sex as a parameter in developing reference values for spirometry.

Dr. Trate DeVolld and Dr. Katie Rivard will explore the efficacy of RSV vaccines and discuss preventive strategies aimed at reducing the occurrence of severe RSV respiratory illness in infants, children, and older adults.

Thomas Gildea, MD, section head of Interventional Pulmonary and Bronchoscopy, discusses Excessive Dynamic Airways Collapse (EDAC) and Tracheobronchomalacia (TBM). He talks about breathing issues that may indicate airway collapse, as well as possible connections with asthma and COPD, long-term corticosteroid use and obesity. Dr. Gildea covers using dynamic CT as a diagnostic tool and treatment possibilities that range from using CPAP to placement of a custom 3D stent.

Dr. Hannah Wang and Dr. Christopher Attaway will explore emerging RSV testing as it pertains to understanding the capabilities and limitations of different diagnostic tests.

Immune checkpoint inhibitors have revolutionized the management of many cancers. However, adverse events and side effects on various organs, including pneumonitis in the lungs, can be caused by these therapies. This episode of Respiratory Exchange Podcast covers patient or therapy side effect risk factors, using tools such as CT scans and bronchoscopy to assist in diagnosis through exclusion and the use of steroid and non-steroids as treatment.

Welcome to a special series by Respiratory Exchange Addressing the Impact of RSV and Vaccine Hesitancy.  In this series, we explore the efficacy of RSV vaccines and discuss preventive strategies aimed at reducing the occurrence of severe RSV respiratory illness in infants, children and older adults.  This episode will focus on the RSV Vaccination for Older Adults, and the importance of vaccination in preventing severe illness and hospitalization. Dr. Ronan Factora explains the risks and the benefits of the RSV vaccine while emphasizing the potential consequences of hospitalization including the loss of independence.

Dr. Michaela Gack explains her research on emerging respiratory viruses and vector-borne pathogens. She discusses the recent advancements in RSV vaccine development while addressing the challenges in RSV epidemiology, vaccination strategies and the importance of education, messaging, and novel approaches in antiviral treatment.

Dr. Siddarth Dugar talks with Congress Co-chair Roshni Sreedharan, MD and Cleveland Clinic Director of Translational Critical Care Research, Vidula Vachharajani, MD about the 2024 SCCM Congress. They discuss interesting sessions such as: identifying modifiable treatments on ARDS, typing of Sepsis biomarkers, whether to get a chest X-ray post-central line placement or not and a late-breaker session on a study involving the impact of head elevation during cardiac arrest. They also talk about a popular session on providing effective review of manuscripts whether they’re for publication or not and offer tips on submitting proposals for the next SCCM Congress.

There have been drastic changes made in the regulation of opioids for medical treatment in the past few decades. However, with advent of fentanyl and carfentanil addiction, overdose-related death continues to increase. In this episode, our guests discuss continued regulation of opioids, use of naloxone and when it may not counteract an overdose, the case for limiting the use of opiates in elderly populations who have existing co-morbidities, and how the use of opioids in certain populations continues to be appropriate.

In the ICU, each patient has a team of professionals on-hand to work with family to promote their well-being. While in-person communication is always best, what happens when that’s not an option – at all? Dr. Adi Gerblich talks about how the ICU at Cleveland Clinic Hillcrest Hospital pioneered virtual ICU rounding years before COVID made it necessary for everyone to go virtual. Hear about the hurdles surpassed, lessons learned and connecting with family members.

Dr. Cyndee Miranda and Dr. Joseph Khabbaza ,experts from the Infectious Disease and Pulmonary Medicine departments at Cleveland Clinic respectively, delve into NTM: how developing an index of suspicion can help identify patients early, what diagnostic criteria work well, when watchful waiting is called for, and the benefits of following a guideline-based regimen to determine success.

Sleep experts Loutfi Aboussouan, MD and Reena Mehra, MD join this episode of Respiratory Exchange to discuss identifying sleep apnea in patients, improving CPAP patient compliance and device alternatives for treatment including hypoglossal nerve stimulation.

Dr. Aanchal Kapoor covers some of the highlights from the CHEST 2023 conference with Drs. Angel Coz and Colin Gillespie including: procedure simulations, transfusion in the ICU, networking at the conference, pros and cons of artificial intelligence in critical care, controversies in mechanical ventilation, sepsis, ARDS, flexible vs rigid bronchoscopy, rescue strategies for hard to ventilate patients, neuro-critical care, the importance of case-based discussions and suggestions for submitting session proposals for future CHEST conferences.

What do golf clubs, computers and aerospace engineering have in common? They all use a beryllium alloy as part of their manufacturing process. Beryllium is used in many industries and, over time, workers who are in contact with this element can become sensitized to it and may develop chronic beryllium disease. Dr. Maeve MacMurdo discusses ways to identify patients who may be sensitized, as well as those who have developed chronic beryllium disease and how they can be treated.

Eduardo Mireles, MD, director of the Medical Intensive Care Unit and vice-chair of the Department of Critical Care Medicine at Cleveland Clinic, discusses the current gap between ventilator technology, with its multiple options, and the education needed for providers who monitor patients. He reviews the course he developed to address this gap, the Standardized Education on Ventilatory Assistance (SEVA), as well as where AI and the detection algorithms used in mechanical ventilation will take healthcare in the future.

Dr. Fred Hsieh discusses eosinophilic-related diseases and their possible causes, such as allergic diseases or parasitic infection. He covers the best way to proceed when your CBC report shows a high eosinophil number and what hypereosinophilia syndrome actually is. Dr. Hsieh reviews the challenge in treating eosinophilic-related diseases with corticosteroids, and new, FDA-approved treatments that use eosinophil-targeting biologics to reduce the eosinophils in the blood.

ATS LIVE! Part 2 Interviews from the 2023 American Thoracic Society Conference Host: Amy Attaway, MD Recorded live at ATS, Dr. Amy Attaway talks with attendees about their emerging and innovative work. Dr. Anna May: Medication use before starting positive airway pressure therapy. Dr. Neha Solanki: Platelets’ association with severe asthma. Dr. Peng Zhang: Repurposing medications to decrease asthma inflammation. Dr. Uddalak Majumdar: Mechanical ventilation and obstructive airway diseases.

Recorded live at ATS, Dr. Amy Attaway, Associate Director of the Cleveland Clinic COPD Center, talks with attendees about their emerging and innovative work:•Dr. Elizabeth Regan: COPDGene study.•Drs. Onder Yildirim and Thom Conlon: COPD iNET.•Dr. Roger Kim: AI radio mix tool. Racial disparities in lung cancer screening.

Dr. Rachel Scheraga and Dr. Brian Southern in the Respiratory Institute at the Cleveland Clinic, cover the best of the 2023 ATS conference. They highlight discussions on recent IPF trials, omics and spatial transcriptomics, incorporating wearables data in clinical trials, climate change impact on lung disease risk and behavior, the updated pulmonary hypertension guidelines and more.

This underrecognized disease is too often diagnosed late in the fungal infection’s fibrotic progression. Learn how using a combination of CT scans, bronchoscopy and the assistance of interventional radiologists can help you diagnose and differentiate fibrosing mediastinitis from other pulmonary disorders such as asthma or COPD. Also in this episode, multiple palliative modalities for fibrosing mediastinitis are discussed that can help improve the quality of life of your patient.

Occupational lung disease is anything related to exposures that occurred on the job. This includes something that may be happening now or happened 20, 30 years ago. Hear why talking to your patient about their job or deployment history may be key to determining lung disease origin and developing a successful treatment plan.

Dr. Maryam Valapour, director of Lung Transplant Outcomes Research at Cleveland Clinic, discusses the intersection of transplant science and health policy and the role of the physician-scientist. She also covers the need to build better lung allocation models, the concept of minimizing the impact of geography in organ distribution, looking into who doesn't get access to transplant that should and increasing the organ donor pool.

Alpha-1 antitrypsin deficiency is a genetic disease that commonly goes unrecognized. For some patients who have COPD or emphysema, alpha-1 is a predisposing condition they have that can be identified through a simple blood test. In this episode, Dr. James Stoller discusses this disease, effective therapies and novel treatments being investigated that include corrector molecules, gene editing approaches and more.

Military burn pits were used during deployment to burn away any kind of waste created. The fumes produced have caused serious lung injury and disease. Drs. Mauve MacMurdo and Neha Solanki discuss burn pit exposure, legislation designed to help military who have developed deployment-related lung disease, and the need to evaluate and support these patients.

Dr. Peter Mazzone talks with Drs. Sethi Sonali and Angel Coz about some of the highlights from the CHEST 2022 conference, including the two-part Critical Care Year End Review covering mechanical ventilation, neurology, ICU, sepsis, ARDIS and surgical critical care.

Dr. Humberto Choi, director of Cleveland Clinic’s Smoking Cessation Program, discusses ways for clinicians to be proactive and individualize treatment options to help people quit smoking. He also reviews electronic cigarettes, vaping and why they aren’t a safer alternative to smoking tobacco.

Dr. Elliot Dasenbrook, founder and director of the Cleveland Clinic Adult Cystic Fibrosis Program, discusses the formation of the multidisciplinary adult program. He covers past treatments and how the new modulators have made such a dramatic difference for patient care, including patients on the lung transplant waiting list. Dr. Dasenbrook also talks about how the need for transitional care, from pediatric to adult care, of the CF patient has become an imperative particularly as CF patients now live well into adulthood.

Liver disease presents a high burden, both on the society as well as healthcare system. Dr. Aanchal Kapoor, founder and director of the Medical Intensive Liver Unit (MILU), talks about the creation of this ICU Critical Care unit completely dedicated to the care of patients with severe liver disease. Dr. Kapoor discusses how this multidisciplinary unit works with staff from multiple areas including transplant hepatology, liver transplant surgery, physical therapy, dieticians, social workers, transplant coordinators and hepatology.

Dr. Daniel Culver, chairman of the Pulmonary Department in the Respiratory Institute at Cleveland Clinic, dives in to the topic of interstitial lung diseases, their diagnosis and management. He covers use of transbronchial cryobiopsy, the benefits of multidisciplinary discussion, and changes in the use of immunosuppressive and anti-fibrotic therapies. Dr. Culver talks about the need for identifying and taking care of comorbidities as a critical part of managing care of these patients, and offers some considerations on the future of diagnosis and therapies.