Dr. An Pham, a pulmonologist from Pennsylvania, USA, shares his opinion on stress and quality of sleep, tobacco taxation, and advancements in procedures and drugs in the treatment of pulmonary conditions.
What inspired you to specialise in pulmonology and what is the most interesting aspect of working in this area?
I did a rotation with a wonderful pulmonologist who became my mentor and made me want to follow in his footsteps.
You are certified in sleep medicine. What are your thoughts on new trends like home sleep tests, for example? Currently, the American Academy of Sleep Medicine recommends home sleep tests should be used in conjunction with a comprehensive sleep evaluation to diagnose obstructive sleep apnoea (OSA).
Mixed feelings. Most of the time this works out, but a lot of times the results come back inconclusive and have to be repeated. Additionally, the Apnoea Hypopnea Index (AHI) is frequently underestimated, which impacts treatment decisions, especially for borderline cases.
Short sleep duration has been associated with a variety of adverse cardiovascular outcomes in cross-sectional and small prospective studies. As someone with more than 20 years of medical practice, during your career have you noticed much indication of lifestyle directly influencing quality of sleep and resulting in other health issues?
That varies from individual to individual. In general, yes, to some degree, but many patients don’t even realise that.
The percentage of the population in the United States that smoke has declined from 20.9% in 2005 to 15.5% in 2016. However, cigarette smoking remains the leading cause of preventable disease and death in the country. Do you agree with measures trying to address this? The Australian government, for example, has announced it will raise tax on tobacco by 12.5% every year from 2017-2020. Would you agree with something similar being put in place in the US?
Mixed feelings. The effect of cigarettes on health is no longer a secret, so if someone chooses to smoke he or she is willing to take that risk. It’s the same with alcohol. I’m not sure where to draw the line as far as controlling what people do with their lives.
In your opinion, how has technology improved the treatment of pulmonary diseases in the last decade?
Lung transplants and interventional pulmonology have advanced significantly. Older patients can now be candidates for lung transplants. Many patients can now avoid surgery given new intervention bronchoscopy procedures. Also, new drugs, especially the biologic agents, have improved patient outcomes significantly.