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Leading the Industry in Pulmonary Care

Helping patients with acute and chronic lung conditions breathe easier

 
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ABOUT SBPA

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

  • Shunt studies

  • 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

Inpatient Services

  • 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.

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OUR DOCTORS

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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>

Download Curriculum Vitae

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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>

Download Curriculum Vitae

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CONTACT US

2403 Castillo Street, Suite 206

Santa Barbara, CA 93105

Office: 805.898.8840

Fax: 805.898.8842

Monday - Thursday

8:30am - 5:00pm

Friday

8:30am - 12:00pm

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DIRECTIONS

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.

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Outpatient Treatment Options for COVID 19

Updated March 25th 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) 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 on their vaccination status and risk for progression. We do not use COVID-19-specific therapy for individuals without 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.

 

•Unvaccinated individuals or those with likely inadequate vaccine response – For such individuals who have symptomatic mild to moderate COVID-19 and risk for progression  we recommend early treatment with nirmatrelvir-ritonavir or sotrovimab rather than no therapy. These agents can reduce the risk of COVID-19 associated hospitalization and death.

 

•Vaccinated individuals – For immunocompetent, vaccinated individuals who have symptomatic mild to moderate COVID-19 and are at high risk for progression to severe disease we also suggest treatment with nirmatrelvir-ritonavir or sotrovimab rather than no therapy. However, it is reasonable to forgo treatment for such patients if the risk of progression is not especially high (eg, they are relatively young with only a single risk factor). Immunocompetent vaccinated patients are likely to benefit from these treatments, although their overall risk is lower than in unvaccinated individuals.

 

Remdesivir and high-titer convalescent plasma are alternative treatments when nirmatrelvir-ritonavir or sotrovimab are not available; low-titer convalescent plasma is not appropriate. For those who cannot use or access any of these agents, molnupiravir is an option; however, it may not be as effective and is potentially teratogenic.

 

The monoclonal antibody bebtelovimab is active against the globally prevalent Omicron variant, but data to support its use are limited. Other monoclonal antibodies available for treatment are not active against Omicron but may become appropriate for therapy if other variants emerge.

 

When supplies of these agents (and the resources necessary for administration) are insufficient to offer treatment to all eligible adults, we agree with the NIH COVID-19 treatment guidelines panel to prioritize immunocompromised individuals who are likely to have a suboptimal response to vaccination and unvaccinated or incompletely vaccinated individuals who have the highest risk for progression to severe disease

 

Outpatient therapies of limited or uncertain benefit – Other treatments are under investigation for outpatients with nonsevere COVID-19, and evidence supporting their efficacy continues to evolve. However, high-quality data are limited and none are recommended for use outside of a clinical trial. A catalog of clinical trials can be found at covid-trials.org; the list of trials can be filtered by setting (eg, outpatient versus inpatient).

 

In non-hospitalized patients, we do not treat COVID-19 with dexamethasoneprednisone, or other corticosteroids. However, in resource-limited settings with limited hospital capacity, it may be reasonable to treat select COVID-19 outpatients who have a new or increased supplemental oxygen requirement with dexamethasone if close clinical follow-up can be assured. In addition, patients with a concomitant acute exacerbation of asthma or chronic obstructive pulmonary disease (COPD) should receive appropriate treatment with systemic glucocorticoids as indicated.

 

For patients with documented COVID-19, treatment with antibiotics is not indicated. Data are limited, but bacterial superinfection does not appear to be a prominent feature of COVID-19. Further, we do not routinely initiate anticoagulation or antiplatelet therapy.

 

Counseling on warning symptoms – We counsel all patients on the warning symptoms that should prompt reevaluation, including new onset or worsening dyspnea, dizziness, and mental status changes such as confusion.

Please note the treatments for COVID 19 are evolving day to day, so please call our office for any updates or questions.

UpToDate accessed March 25th 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. 

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COVID-19 BOOSTER VACCINATION 
Updated March 25th 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 12 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. 

 

●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 vaccine dose, which is also given two to three months after the last dose of the primary series. 

 

●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.

UpToDate accessed March 25th 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
March 25th 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.

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