Our mission at Santa Barbara Pulmonary Associates is to provide comprehensive state of the art pulmonary care to the Central Coast communities and beyond. We are committed to improving the health of our patients with acute and chronic lung disease through exceptional and compassionate care. Our physicians are board certified in pulmonary and critical care medicine and have special expertise in the care of patients with cystic fibrosis, bronchiectasis, COPD, asthma, interstitial lung disease, asbestos related lung disease and lung cancer. We strive to build strong partnerships built on trust and respect with our patients while collaborating with their other health care providers so that care is personalized and treatments are as effective as possible.
Outpatient Services and Advanced Pulmonary Diagnostics
Comprehensive pulmonary consultation
Complete pulmonary function testing
Arterial blood gases
Cardiopulmonary exercise testing
Exercise induced bronchoconstriction testing
Six-minute walk tests
Oxygen titration studies
High altitude simulation tests
Airway Clearance teaching and review
State-of-the-art diagnostic and therapeutic bronchoscopies including use of ultrasound technology and robotic navigational bronchoscopy
Placement of endobronchial valves for the treatment of emphysema and bronchopleural fistula
Santa Barbara Pulmonary Associates provides inpatient pulmonary and critical care consultation at Santa Barbara Cottage Hospital
Virtual Visit/Telemedicine Program
Santa Barbara Pulmonary Associates, in the setting of COVID-19, has started a robust virtual visit program and have recently transitioned from Spruce Health to a new more robust platform Zoom through Elation, our Electronic Health Record. This is an excellent HIPAA compliant platform that enables private video and audio communication between patients and their physicians.
Virtual visits allow convenient appointments as well as ease of scheduling and safety in the setting of the COVID-19 pandemic to our patients. Most importantly, they allow us to stay connected with our patients and their loved ones, especially during this period when patients are feeling isolated as a result of the pandemic.
Please contact our office if you are interested in learning more about virtual visits. If accessing appropriate virtual visit technology is difficult, please discuss any issues you are encountering with our office staff, who are available to assist you. Telephone visits are also now possible. Virtual visits and telephone visits are now being reimbursed by most government and commercial insurance plans.
ROBERT S. WRIGHT, MD, FACP, FCCP, FRCP (C)
Dr. Wright graduated from Occidental College with a B.A. in Chemistry and he received his medical degree from the University of Southern California. He completed his training as a Medical Intern, Resident and Chief Resident in Internal Medicine at the UCLA Center for the Health Sciences and subsequently as a Fellow in Nephrology at UCLA. He practiced nephrology for four years in Santa Barbara and completed further training as a Fellow in Pulmonary Medicine at the UCLA Center for the Health Sciences. He returned to Santa Barbara in 1990. He is board certified in Pulmonary Diseases, Critical Care Medicine, Nephrology and Internal Medicine. He is a Fellow of the American College of Chest Physicians, the Royal College of Physicians and Surgeons of Canada, and the American College of Physicians. Read More>
RICHARD A. BELKIN, MD, MSCE, FCCP
Dr. Belkin has practiced Pulmonary and Critical Care Medicine in Santa Barbara since 2004. Dr. Belkin thoroughly enjoys the practice of both outpatient and inpatient pulmonary and critical care medicine, with a special interest and expertise in the care of cystic fibrosis (CF) and bronchiectasis patients. He strives to provide comprehensive personalized care with a holistic approach with excellence, integrity and compassion in the care of his patients. He grew up in West Chester, Pennsylvania (near Philadelphia). He completed his undergraduate work in biology at Brandeis University in Waltham, Massachusetts, graduating cum laude in 1993. He obtained his medical degree (M.D.) from the University of Pennsylvania School of Medicine in 1997 where he was awarded the Gates Pharmaceutical Outstanding Student Award. Read More>
Conveniently located across the street from Santa Barbara Cottage Hospital Emergency Room. The office is on the second floor of the Cottage Outpatient Surgery building.
Parking available on the ground floor and the underground garage. Wheelchair accessible. Elevator access to our second floor office.
Outpatient Treatment Options for COVID 19
Updated July 4th 2022
Outpatient management strategies continue to evolve – Data informing outpatient coronavirus disease 2019 (COVID-19) management strategies continue to evolve, particularly in the setting of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants; the approach described here is based upon a rapidly developing evidence base. Clinicians should take into account the individual patient's clinical and social circumstances as well as the available resources when considering treatment options.
Outpatient management appropriate for majority of patients – Outpatient management is appropriate for most patients with COVID-19. When possible, we favor a coordinated care management program that includes initial risk stratification, clinician telehealth visits, a dedicated outpatient respiratory clinic, and a close relationship with a local emergency department (ED).
Initial evaluation; evaluation of acuity and risk stratification – On initial evaluation, we assess risk factors for severe disease dyspnea severity and duration (and oxygenation status of those with dyspnea, if that information is available), overall level of acuity, and the patient’s home setting to determine who warrants an in-person evaluation at an outpatient clinic or in the ED. The additional criteria we use to make this determination are not fixed and will vary by institution, region, and over time as resource availability and treatment options evolve.
We typically refer patients with one or more of the following features to the ED for further management and likely hospital admission:
•Severe dyspnea (dyspnea at rest, and interfering with the ability to speak in complete sentences)
•Oxygen saturation on room air of ≤90 percent, regardless of severity of dyspnea
•Concerning alterations in mentation (eg, confusion, change in behavior, difficulty in rousing) or other signs and symptoms of hypoperfusion or hypoxia (eg, falls, hypotension, cyanosis, anuria, chest pain suggestive of acute coronary syndrome)
We refer patients for evaluation in an outpatient clinic if they have one or more of the following features without any of the preceding features:
•Mild dyspnea in a patient with an oxygen saturation on room air between 91 to 94 percent
•Mild dyspnea in a patient with any risk factors for severe disease
•Moderate dyspnea in any patient
•Symptoms concerning enough to warrant in-person evaluation (eg, mild orthostasis) but not severe enough to require ED referral
The decision to refer patients for hospital admission or manage at home depends upon several factors, including their requirement for supplemental oxygen, an assessment of their overall acuity level, and hospital resources and capacity.
Other patients can generally remain at home for management without in-person evaluation if they can reliably report worsened symptoms and can self-isolate for the anticipated duration of illness. Some outpatients may be candidates for COVID-19-specific therapy, if available. We generally do not schedule routine telehealth follow-up visits for patients managed at home, although we reach out to those patients about whom we have concerns (eg, older adults who live alone, individuals who may not be able to reliably self-report worsening of symptoms) by telephone as our resources permit.
COVID-19 specific-therapy – Our recommendations for treating outpatients with symptomatic COVID-19 depend upon patient age, vaccination status, and risk for progression to severe disease. We do not use COVID-19-specific therapy for vaccinated individuals ≤65 years of age without any risk factors for severe disease, or for individuals who have asymptomatic SARS-CoV-2 infection. All COVID-19-specific therapies should be administered as soon as possible after symptom onset. (Note that the first day of symptoms is day 0, the next day is day 1, and so forth.)
•Nonpregnant, vaccinated adults ≤64 years with no risk factors – For immunocompetent adults aged ≤64 years who are up to date with recommended COVID-19 vaccinations and who have no other risk factors for progression to severe disease, we do not offer treatment with COVID-19-specific therapy. In such patients, the overall risk of progression to severe disease is low enough that the absolute benefit of treatment may not outweigh any potential risk of harm (eg, medication adverse effects, risk of "rebound COVID-19" requiring extension of the isolation period). It may also be reasonable to forgo treatment in immunocompetent, vaccinated individuals in this age group if they have only a single, less "significant" risk factor such as hypertension.
•Nonpregnant adults who are at increased risk for severe disease due to comorbidities and/or vaccination status – For individuals who have symptomatic mild to moderate COVID-19 and are at increased risk for progression to severe disease due to comorbidities and/or vaccination status, we recommend early treatment with nirmatrelvir-ritonavir rather than no therapy. Such individuals include immunocompromised adults and those with multiple risk factors for progression to severe disease (regardless of age, vaccination history, or prior receipt of COVID-19 prophylaxis therapy); and immunocompetent individuals >50 years who are not up to date with recommended COVID-19 vaccinations regardless of risk factors. Nirmatrelvir-ritonavir can reduce the risk of COVID-19 associated hospitalization and death , and the expected benefit of treatment in these patients is likely substantial.
•Nonpregnant adults who are at increased risk for severe disease due to age – For nonpregnant, immunocompetent adults ≥65 years who have symptomatic mild to moderate COVID-19 and who are up to date with recommended COVID-19 vaccinations , we also suggest treatment with nirmatrelvir-ritonavir rather than no therapy (Grade 2C); even in the absence of additional risk factors, advanced age alone justifies treatment in the majority of these patients.
We engage all eligible patients in shared clinical decision-making, considering their individual risk factors as well as values and preferences.
Prior to prescribing nirmatrelvir-ritonavir, clinicians should review prescribed and over-the-counter medications and assess potential drug interactions. Specific drug interactions can be checked through the Lexicomp Drug Interaction tool or the drug interaction checker from the University of Liverpool.
Remdesivir is another effective alternative, although it requires intravenous administration over three days .
Monoclonal antibodies — Anti-SARS-CoV-2 monoclonal antibodies are alternative options for COVID-19-specific therapy for symptomatic outpatients with risk for progression to severe disease. However, monoclonal antibodies have variable activity against the different SARS-CoV-2 variants, and agent selection must consider the susceptibility of circulating variants. As an example, although sotrovimab has activity against the BA.1/BA.1.1 sublineages of the Omicron variant; it does not have activity against the BA.2 sublineage and is no longer authorized to treat COVID-19 in the United States since BA.2 has become the predominant variant.
In addition, these agents have limited availability, require parenteral administration, and must be given early in the course of illness; these factors make administration operationally complicated in many outpatient settings.
Bebtelovimab is active against all circulating Omicron sublineages (including BA.2) and has received an EUA in the United States for non-hospitalized patients who have mild to moderate COVID-19, are at risk for progression to severe disease, and cannot get other COVID-19 therapies. However, data to support its use are limited mainly to an unpublished trial among low-risk outpatients, in which bebtelovimab reduced the time to sustained symptom resolution to six days from eight days with placebo. The risk of COVID-19 associated hospitalization and death was similarly low with bebtelovimab and placebo (1.6 percent).
Bebtelovimab is administered as a single 175 mg IV dose as soon as possible after diagnosis and within seven days of symptom onset. Bebtelovimib may be obtained locally at the GVCH and SBCH Emergency departments
Please note the treatments for COVID 19 are evolving day to day, so please call our office for any updates or questions.
References: UpToDate accessed July 4th 2022
COVID-19 VACCINE UPDATE FOR SBPA PATIENTS
The physicians at SBPA strongly recommend you receive the COVID 19 vaccine. We recommend any of the three vaccines which are authorized and recommended in the United States by the CDC to prevent COVID 19
Please go to My turn to schedule an appointment at local vaccine administration sites.
COVID-19 BOOSTER VACCINATION
Updated July 4th 2022
●Booster doses – We recommend booster vaccination for eligible individuals. Effectiveness of the primary series wanes over time, and a booster dose can further reduce the risk of symptomatic infection. In the United States, a booster dose has been authorized for those 5 years of age and older. For most individuals, the booster dose is given at least five months after a primary Pfizer-Bionetch or Moderna series and at least two months after a primary Janssen series. Any one of the three vaccines can be used as a booster dose, regardless of the vaccine used for the primary series, as long as it is approved or authorized for the age group. However, as above, we favor one of the mRNA vaccines. For individuals who are older than 50 years of age or are 12 years of age or older and have certain immunocompromising conditions, we also suggest a second booster dose with an mRNA vaccine at least four months after the first booster
●Adjustments for immunocompromised patients – For individuals with certain immunocompromising conditions, we suggest administering a three-dose primary mRNA vaccine series rather than a two-dose series. Similarly, we suggest an additional mRNA vaccine dose for such individuals who previously received a single Janssen dose. Immunocompromised individuals are less likely to respond adequately to routine vaccination; additional doses are associated with improved vaccine effectiveness. These additional doses do not replace the booster doses, the first of which is given two to three months after the last dose of the primary series, and the second of which is given four months after the first.
●Deviations from dosing recommendations – If the vaccine is administered in a manner different from the recommended approach, the dose or series generally does not have to be repeated . Centers for Disease Control and Prevention (CDC) recommendations on how to manage vaccination errors or deviations are presented are on the attached link.
●Expected side effects – Vaccine recipients should be advised that side effects are common and include local and systemic reactions, including pain at the injection site, fever, fatigue, and headache. Analgesics or antipyretics (eg, nonsteroidal anti-inflammatory drugs [NSAIDs] or acetaminophen) can be taken if these reactions develop, although prophylactic use of these agents before vaccine receipt is generally discouraged because of the uncertain impact on the host immune response to vaccination.
●Contraindications and precautions – The primary contraindications to COVID-19 vaccination are severe or immediate allergic reactions to the vaccine or any of its components. All individuals should be monitored for an immediate reaction for at least 15 minutes following vaccination. Individuals without a contraindication who have a history of anaphylaxis of any kind, an immediate allergic reaction to other vaccines or injectable therapies, or a contraindication to a COVID-19 vaccine class other than the one they are receiving should be monitored for 30 minutes.
●Impact of variants on vaccine efficacy – Several SARS-CoV-2 variants with potential for immune escape have been identified worldwide. Vaccine effectiveness against Delta is reduced against overall infection but largely retained against severe disease. Evidence suggests attenuated vaccine effectiveness, particularly against overall infection, with Omicron (B.1.1.529); prevention against hospitalization following a booster dose remains relatively high, at least in the short term.
References: UpToDate accessed July 4th 2022
Please refer to the CDC website for more information about the COVID-19 vaccine including 3rd dose and booster vaccines.
As the guidelines for COVID-19 3rd dose and booster vaccination continue to evolve, if you have questions about whether 3rd dose or booster vaccine is right for you, please contact us at SBPA to discuss further.
SBPA COVID-19 CORONAVIRUS UPDATE
July 4th 2022
We take every measure recommended by the Centers for Disease Control (CDC) and the Santa Barbara County Public Health Department and other local public health experts to provide a safe health care environment for you when you come into our office. You will be screened for symptoms of COVID 19 both at the time of appointment confirmation as well as on arrival to the office. YOU ARE STILL REQUIRED TO WEAR A FACE MASK AT ALL TIMES IN OUR OFFICE regardless of vaccination status consistent with CDC guidelines for healthcare facilities.
Please inform us if you are experiencing any symptoms consistent with COVID-19 including fever, new cough, shortness of breath, loss of smell or other concerning symptoms as your appointment may need to be rescheduled or changed to a virtual visit.
We continue to require you to wear a mask when entering our office and throughout your visit and maintain social distancing with others of at least 6 feet. Our waiting room has been arranged to facilitate adequate distancing. To maximize patient safety, we have placed Molekule air purifiers in our waiting room and throughout our office to significantly decrease risk of spread of COVID-19. Hand sanitizer is available throughout the office for your use. Our staff will take every safety measure for our mutual protection, including strict use of appropriate personal protective equipment.