Annoying CT Results? Maybe Pulmicort Can Save the Day!

Doctors are supposed to practice evidence-based medicine—prescribing treatments backed by solid research, clear indications, and measurable benefits. But what happens when they start making things up?

Take this case: a patient  who recently had a CT scan. The scan showed "a few tree-in-bud infiltrates, which could indicate infection, inflammation, or aspiration." according to the report. There were also no systemic signs of infection. 

The doctor wrote in his notes: "Will trial Pulmicort for this." He followed through and prescribed Pulmicort (budesonide) at 0.25 mg BID—a pediatric dose nonetheless.

The problem? Aside from the pediatric dose, the CT scan alone doesn’t justify ICS therapy. There aren’t any well-established studies supporting this approach. In fact, I doubt it has even been studied. In fact, I even used AI to try to find one, and AI came up empty. That says a lot.

So why did the doctor prescribe it anyway?

Possible Explanations (None of Them Good)

• Guesswork – The doctor doesn’t know what to do and is throwing an ICS at the problem, hoping for the best.
• Overtreatment Culture – Some doctors feel the need to “do something,” even when doing nothing is the better option.
• Misinterpretation of Evidence – The doctor may think ICS reduces inflammation in any lung condition, despite the lack of proof for this scenario.
• Covering Their Bases – Writing a prescription makes it look like they’re addressing the issue, even if there’s no clear benefit.

What the Science Actually Says

There’s no established research supporting the use of ICS in asymptomatic patients based solely on CT findings. Worse, unnecessary ICS use carries risks: increased susceptibility to pneumonia, and oral thrush.

The Bigger Issue: When Doctors Prescribe Without Evidence

This isn’t just about one bad prescription—it’s about a broader problem in medicine. When doctors ignore evidence-based guidelines and prescribe treatments without justification, it doesn’t necessarily undermine patient trust. Most patients don’t question what they’re given; they simply accept what the doctor orders.

The people who do question these decisions? Respiratory therapists like me—the ones actually administering the treatments. We see firsthand that these treatments are a waste of time and money. When there’s no clear benefit, no solid evidence, and no logical reason for a prescription, it’s frustrating to be the one carrying it out. Instead of blindly following orders, we should be asking the real question: Why are we doing this in the first place?

Medicine should be guided by science, not guesswork.

Final Thoughts

When doctors prescribe treatments without solid evidence, they’re not helping patients—they’re relying on assumptions. That’s a problem.

Meanwhile, the doctor might feel good about “doing something.”
But to me, it’s just another pointless task.

And for the patient?
It’s one more unnecessary treatment.

Sadly, there's a lot of this type of waste in healthcare.