People with HIV (PWH) have a higher burden of respiratory comorbidities than the general population, yet emerging spirometry impairments such as preserved ratio impaired spirometry (PRISm) and restrictive spirometry patterns (RSP) have received limited attention.

Poor outdoor air quality episodes-driven by wildfire smoke, traffic-related emissions, and unfavorable atmospheric conditions-are increasingly common, and patients routinely ask whether and how to continue exercising outdoors. The health benefits of regular physical activity are well established, yet exposure to fine particulate matter (PM2.5) and ozone (O3) is associated with adverse cardiopulmonary outcomes; during exercise, increased minute ventilation increases inhaled dose, sharpening the clinical counseling dilemma. Existing recommendations from public health and professional organizations largely provide population-level messaging and are not optimized for rapid, individualized decisions in routine outpatient care. In this How I Do It article, we translate epidemiologic, experimental, and guideline-based evidence into a pragmatic counseling approach anchored to the U.S. Air Quality Index (AQI). We present a four-step framework: (1) stratify patients by cardiopulmonary vulnerability; (2) interpret local, real-time, pollutant-specific air quality data; (3) apply AQI-based action thresholds tailored to risk tier; and (4) prescribe specific, operational modifications to exercise timing, location/route, intensity, and duration, with mitigation strategies when exposure cannot be avoided. This framework emphasizes dose reduction and modification rather than blanket cessation, explicitly acknowledges heterogeneity in individual susceptibility and access to mitigation resources, and supports shared decision-making at the point of care. By integrating air quality awareness into routine exercise counseling, clinicians can deliver clear, equitable, and clinically actionable guidance that helps patients remain active while minimizing avoidable exposure during pollution events.

Chronic lung disease and heart failure (HF) commonly co-occur, share modifiable risk factors, and are preceded by a prolonged, heterogeneous, and subclinical phase that is poorly defined.

Night-to-night variability (NtNV) in polysomnography (PSG) contributes to diagnostic uncertainty in obstructive sleep apnea (OSA), yet multi-metric evaluations using closely spaced PSG nights-particularly in moderate-to-severe disease-remain limited. The comparative stability of apnea-hypopnea index (AHI) definitions, hypoxic burden (HB), and threshold calibration remains unclear.

Climate conscious inhaler prescribing involves preferential selection of low carbon footprint devices while considering patient safety and preferences.

A 65-year-old man with a history of paroxysmal atrial fibrillation, OSA, and remote cigarette smoking was referred to the Thoracic Surgery clinic for a posterior mediastinal mass in the setting of progressively debilitating neurologic symptoms of the face and neck.

A 78-year-old woman with gastroesophageal reflux disease was admitted with 2 months of progressive dyspnea on exertion and leg swelling. At baseline, she could walk 10 blocks; at presentation, she managed less than 6 steps. For a month, she had been sleeping upright in a chair. She experienced no fever, cough, palpitations, or chest pain. With prompting, she shared a several-year history of discomfort and skin changes in her fingers; she attributed these symptoms to chemical exposures as a housecleaner.

A 13-year-old boy was transferred to our institution for evaluation of a large, unexplained pleural effusion. He had a 1-month history of progressive dyspnea, accompanied by a 2-week history of fevers and a 2-kg weight loss, which was notable given his lean build. A chest CT scan performed at an outside hospital had revealed a large left-sided pleural effusion with associated low-density lesions in the sternum and vertebrae. A thoracic drainage tube had been placed, draining approximately 500 mL of turbid fluid daily. The patient's family reported no history of recent travel or exposure to pets.