Clinical decision support that reasons like a pulmonologist: treat the exacerbation, step asthma up by control, work up the embolism, and follow the nodule by the interval it actually earns — with the decision rule and exactly what would change it. Built for verified physicians.
Two real pulmonology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Known COPD, three days of worsening dyspnea with more sputum that has turned purulent — the exacerbation plan?
Treat the exacerbation as a bundle: short-acting bronchodilators, a short course of systemic corticosteroid — prednisone 40 mg for five days is as effective as longer courses — and antibiotics when two of the three Anthonisen cardinal symptoms are present (more dyspnea, more sputum, purulence) or the patient is ventilated. Titrate controlled oxygen to a target SpO2 of 88–92% to avoid CO2 narcosis, and start non-invasive ventilation for hypercapnic respiratory failure with a pH below 7.35.
Decision ruleCOPD exacerbation → bronchodilators + prednisone 40 mg for 5 days; antibiotics if 2 or more Anthonisen symptoms or ventilated; oxygen to SpO2 88–92%; NIV for pH below 7.35.
Not established from this alone — the blood gas, severity, comorbidity and prior exacerbations change the plan.
An incidental solid 7 mm lung nodule on CT in a 60-year-old current smoker — the follow-up?
Apply the Fleischner Society 2017 criteria, which key on nodule size, solid-versus-subsolid morphology and the patient risk. A single solid nodule of 6–8 mm in a high-risk patient is followed with CT at 6–12 months and again at 18–24 months; suspicious morphology or growth moves to PET-CT or biopsy. Fleischner does not apply to lung-cancer screening, known cancer, or patients under 35.
Decision ruleIncidental solid 6–8 mm nodule, high risk → Fleischner: CT at 6–12 mo, then 18–24 mo; escalate to PET or biopsy for growth or suspicious morphology; Fleischner excludes screening, known cancer, age under 35.
Not established from this alone — the size, morphology, growth and the patient risk profile change the interval.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Give short-acting bronchodilators, a systemic corticosteroid — prednisone 40 mg daily for five days, no longer — and antibiotics when at least two Anthonisen cardinal symptoms are present or the patient is mechanically ventilated. Deliver controlled oxygen to a target SpO2 of 88–92%, and start non-invasive ventilation for acute hypercapnic respiratory failure with a pH under 7.35. Then reassess inhaler technique, vaccination and the maintenance regimen.GOLD
Decision ruleBronchodilators + prednisone 40 mg for 5 days; antibiotics if 2 or more Anthonisen symptoms or ventilated; controlled oxygen to SpO2 88–92%; NIV for pH below 7.35.
Missing data: the blood gas, the severity and the comorbidity change the intensity of care.
Assess control and technique first, then step up along the GINA track. GINA no longer endorses SABA-only treatment: even mild asthma uses an ICS-containing reliever, with low-dose ICS-formoterol as the reliever and, at higher steps, maintenance-and-reliever therapy. Escalate the ICS dose, add a LABA, and refer for biologics in severe eosinophilic or allergic disease. Confirm adherence and triggers before every step up.GINA
Decision ruleNever SABA-only → ICS-containing reliever; low-dose ICS-formoterol; maintenance-and-reliever at higher steps; step up on control after checking technique and adherence; biologics for severe phenotypes.
Missing data: the control assessment, the technique, adherence and the phenotype change the step.
Stratify the pretest probability with the Wells score. In a low-probability patient who meets all PERC criteria, no testing is needed. Otherwise use an age-adjusted D-dimer to exclude PE in the non-high-probability patient, and go straight to CT pulmonary angiography when probability is high. Once PE is confirmed, risk-stratify with the PESI or sPESI and markers of right-heart strain to choose outpatient care, anticoagulation, or reperfusion.Wells · PERC
Decision ruleWells → PERC-negative and low: stop; else age-adjusted D-dimer to exclude in non-high probability; CTPA if high; then PESI or sPESI plus RV strain to guide disposition and reperfusion.
Missing data: the pretest probability, renal function and hemodynamics change the test and the treatment.
Use the Fleischner Society 2017 recommendations, which depend on nodule size, whether it is solid or subsolid, and the patient risk. Nodules under 6 mm in a low-risk patient need no routine follow-up; solid nodules of 6–8 mm are followed with CT at 6–12 months; larger or suspicious nodules move to shorter-interval CT, PET-CT or biopsy. Subsolid nodules follow their own longer schedule. Fleischner excludes screening, known cancer and patients under 35.Fleischner 2017
Decision ruleFleischner 2017 by size + solid/subsolid + risk: under 6 mm low-risk no follow-up; solid 6–8 mm CT 6–12 mo; larger or suspicious → PET or biopsy; excludes screening, known cancer, age under 35.
Missing data: the size, morphology, growth and risk profile change the interval and the next test.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist pulmonology colleague across airways disease, pulmonary vascular disease, nodules and lung cancer, interstitial disease, infection and sleep — cited, non-directive, always with the decision rule.
Deep specialist agents for interstitial lung disease, pulmonary hypertension, interventional pulmonology and sleep medicine — each its own soul and knowledge base — plus your own uploaded materials.
From the exacerbation bundle to the nodule follow-up interval the margin is thin. Only one of these reasons like a pulmonology colleague whose every claim you can trace.
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It reasons in the frameworks you use — GOLD and GINA, the Wells and PERC rules, PESI and the Fleischner criteria — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Fellows use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on consults and in clinic. Access is gated to verified physicians.
Interstitial lung disease, pulmonary hypertension, interventional pulmonology and sleep medicine each have their own deep specialist agent on the Pro plan, on top of the full pulmonology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited pulmonology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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