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A patient with unilateral bronchiolitis obliterans organizing pneumonia (BOOP) is described in this report. The disease responded well to glucocorticoid therapy, as is characteristic. Although BOOP is being more frequently recognized as bilateral disease to the best of our knowledge, only three previous cases of unilateral disease have been recognized and reported.

Transtracheal oxygen represents an important advance in the technology of long-term oxygen therapy. As an oxygen conserving technique, it allows increased physical activity with smaller ambulatory and portable units and facilitates the management of patients with refractory hypoxemia outside of the hospital. There is increasing evidence that transtracheal oxygen therapy provides significant physiologic benefits beyond those achieved with the nasal cannula because of tighter control of oxygen therapy and fewer episodes of hypoxemia as a result of uninterrupted 24-hour oxygen therapy. Transtracheal oxygen therapy should be viewed as a program for long-term oxygen administration and not simply as a procedure that involves the insertion of a catheter into the tracheal. Careful patient screening and patient education is important to avoid complications. The program is best administered through regional centers with a team approach to patient care.

The high standards of medical practice rest on the assumption that a physician's competence equips him or her to act on a patient's behalf. The conundrum created by medical uncertainty regarding the patient's diagnosis or the appropriate course of treatment seldom receives attention in the medical literature. This article highlights how the age-old medical ideal of beneficence, the modern concept of probabilities, the added dimension of treatment modification based on patients' preferences, and a compassionate disposition operate as competence-supporting tools in high uncertainty medical situations.