Brett Ley, Author at PulmCCM
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Brett Ley

Brett Ley is a pulmonary and critical care fellow at the University of California - San Francisco and a former UCSF medical student, resident, and chief resident - a UCSF lifer. His research interest is in interstitial lung diseases and clinical interest is in all things medical. His free time is spent traveling the world with his wife.

Mar 312013
 
What works to help people with pulmonary fibrosis feel better? (Review)

Interventions to Improve Symptoms, Quality of Life in Fibrotic ILD: Do They Work? by Brett Ley, MD Patients with fibrotic interstitial lung diseases (e.g. idiopathic pulmonary fibrosis) have a poor overall prognosis, and there are no therapies proven to halt disease progression or extend life. Further, many of these patients have debilitating symptoms, limited functional [… read more]

Mar 202013
 
Bactrim for idiopathic pulmonary fibrosis? Intriguing, but not yet (RCT)

Bactrim/Septra for Idiopathic Pulmonary Fibrosis? by Brett Ley, MD Idiopathic pulmonary fibrosis (IPF) is a fatal fibrotic lung disease that lacks proven, effective treatments. Many novel medications have been trialed and painfully failed. So I commend Ludmila Shulgina and colleagues for trying an old medication, trimethoprim-sulfamethoxazole (TMP-SMX), with some preliminary evidence for potential benefit. What [… read more]

Mar 132013
 
Weaning from Mechanical Ventilation Update (Review)

Weaning From Mechanical Ventilation Update (See More PulmCCM Reviews) by Brett Ley, MD Nearly 800,000 patients require mechanical ventilation yearly. There’s no doubt it is a life-saving intervention, but it is one that is fraught with the potential for iatrogenesis, especially if continued for longer than necessary. That is the main message of this review in [… read more]

Feb 122013
 
Pulmonary Hypertension Update, Part 2: Treatment of PH (Review)

Pulmonary Hypertension 2013 Update/Review Part 2 of 2: Treatment of PH Read Part 1: Diagnosis and Classification of Pulmonary Hypertension by Brett Ley, MD There are 3 classes of pulmonary vasodilator drugs: phosphodiesterase-5 inhibitors (PDE-5 inhibitors, e.g. sildenafil, tadalafil), endothelin receptor antagonists (ERAs, e.g. bosentan, ambrisentan), and prostacyclins (epoprostenol, iloprost, treprostinil).  Because the large trials [… read more]

Feb 052013
 
Pulmonary Hypertension Update, Part 1: Classification & Diagnosis (Review)

Pulmonary Hypertension Update/Review Part 1 of 2: Classification and Diagnosis Read Part 2: Treatment of PAH by Brett Ley, MD Pulmonary hypertension (PH) is defined simply as a mean pulmonary artery pressure of 25 mmHg or greater. However, this entity encompasses a heterogeneous group of patients and underlying etiologies where accurate diagnosis, correct physiologic classification, and careful evaluation for [… read more]

Jan 292013
 
Forget "embolic burden" of pulmonary embolism: location is everything

In Most Patients with Pulmonary Embolism, Central Clot is Worse than Peripheral by Brett Ley, MD Pulmonary embolism (PE) presents with a wide range of clinical severity and course. Management decisions (level of care, length of observation, and aggressive therapies such as thrombolysis) are generally based on a patient’s risk of a poor outcome. Guidelines recommend risk [… read more]

Jan 232013
 
Does your COPD patient need in-flight oxygen? New algorithm may help

Who Needs In-Flight Oxygen? New Method May Help by Brett Ley, MD COPD patients without a long-term indication for supplemental oxygen may still be at risk for severe hypoxemia during air travel since cabin pressures are generally maintained to simulate altitudes of about 8000 feet. In-flight supplemental oxygen is recommended when the partial pressure of [… read more]

Dec 112012
 
Predicting survival from COPD exacerbations: DECAF score shows promise

DECAF Score Predicts COPD Exacerbation Mortality, But Needs Validation By Brett Ley, MD Despite improvements in care, death during hospitalization for acute exacerbation of COPD (AECOPD) is not uncommon. In the UK in 2008, almost 1 in 12 people admitted with a COPD exacerbation died in-hospital. In the U.S. in 1996, about 1 in 40 [… read more]