List of some of the disorders we treat with a brief description.
Asthma is a lung condition that causes wheezing, coughing, and shortness of breath. It is caused by inflammation (swelling) of the lining of the airways in your lungs. Asthma is a chronic condition, which means you may have it the rest of your life.
You may start coughing or wheezing when you breathe in irritants or something you are allergic to. Cold air, chemicals, perfume, and smoke are examples of irritants. Examples of things you might be allergic to, called allergens, are dust, pollen, molds, and animal dander. A cold or the flu might also bring on an asthma attack.
Some people have coughing or wheezing only during or after physical activity. This is called exercise-induced asthma.
Asthma may be mild, moderate, or severe. An asthma attack may last a few minutes or for days. Attacks can happen anywhere and at any time. Severe asthma attacks can be fatal. It is very important to get prompt treatment for asthma attacks and to learn to manage your asthma so you can live a healthy, active life.
About 20 million Americans have asthma, and the number of people who have asthma is increasing worldwide.
Chronic obstructive pulmonary disease (COPD) is a condition in which some of your airways are permanently blocked. COPD makes it harder for you to breathe. It causes strain on your heart. It increases the blood pressure in your lungs (pulmonary hypertension) and makes your heart get bigger (cor pulmonale).
How does it occur?
There are 2 main types of COPD: chronic bronchitis (inflamed airways) and emphysema (damage to the lung tissue). Chronic bronchitis and emphysema result from irritation of your airways over a long time, usually from smoking and sometimes from air pollution. Other causes are on-the-job exposure to irritants such as dust or chemicals, or frequent lung infections.
Chronic bronchitis and emphysema can occur separately but often they develop together. In chronic bronchitis, the insides of the airways thicken and swell. This makes the passageway for air smaller. The damaged airways make more mucus, which can block the airways and make it hard to breathe. In emphysema, the tiny air sacs (alveoli) in the lungs may become badly damaged or destroyed and lose their ability to stretch (get bigger and smaller). This makes it harder for you to breathe out carbon dioxide after breathing in air. As the carbon dioxide collects in your lungs, there is less room for oxygen to be breathed in.
COPD is not contagious. You cannot give it to someone or get it from someone else.
Lung cancer is an abnormal growth of cells that starts in the lungs. Lung cancer is one of the most common forms of cancer in the US and is the leading cause of cancer death.
When you breathe, the lungs bring oxygen into the body and take out carbon dioxide. Carbon dioxide is a waste product of the body's cells.
Lung cancer can spread to other parts of the body, most often to the liver, brain, bones, and other parts of the lungs, including the outer lining (called the pleura). Cancer from other parts of the body may also spread to the lungs, but it is different from cancer that starts in the lungs.
How does it occur?
Tobacco is linked to 85 to 90% of cases of lung cancer. In addition to smoking, factors that increase your risk for lung cancer include exposures to:
- other people's smoke (secondhand smoke, or passive smoking)
- air pollution
- radiation at your job or in your environment
- radon gas
- industrial chemicals such as the byproducts from petroleum refining.
Pulmonary fibrosis is an illness in which the air sacs of the lungs become inflamed and are gradually replaced by scar tissue. (The air sacs are called the alveoli.) As the disease worsens, the scar tissue makes it harder to breathe. It becomes harder for the lungs to get oxygen into the bloodstream.
Pulmonary fibrosis is also called interstitial lung disease. It is most common in adults between the ages of 40 and 70.
How does it occur?
There are over 100 causes of pulmonary fibrosis. It may be caused by chronic infection, cancer, or long-term use of drugs. Examples of drugs that might cause it are anticancer drugs, hydralazine, nitrofurantoin, amiodarone, and drugs for rheumatoid arthritis. Other causes include long-term exposure to asbestos, beryllium, silica, and coal dust, and sensitivity to proteins made by animals such as birds and rats.
Pulmonary fibrosis may be hereditary. There are 2 ways in which this may occur. One is that the condition is inherited and symptoms show up later in life, usually in the forties or fifties. Or children may inherit a tendency to be extra sensitive to the known causes of pulmonary fibrosis, such as asbestos. Therefore they may be more likely to develop the condition when they are exposed to these causes.
When the cause of the fibrosis is not known, it is called idiopathic pulmonary fibrosis.
Cystic fibrosis (CF) is a birth defect that causes the body to produce thick, sticky mucus. Usually, mucus is thin and slippery. In cystic fibrosis, the thick mucus causes lung infections and blocks the lungs. This is especially dangerous if it blocks airways and breathing stops. These thick secretions may block the pancreas, which helps the intestines to break down and absorb food. The mucus also can block the bile duct in the liver and cause permanent liver damage over time.
CF can affect all races and ethnic groups, but occurs mostly in whites. It affects people in different ways and by varying degrees.
How does it occur?
CF is caused by defective genes that are passed from parent to child. A child must inherit a defective CF gene from each parent to have CF. If the child only gets one CF gene, he or she is a carrier of the disease, but does not have it. If both parents have the cystic fibrosis gene, there is a 25% chance that each child they have will have CF.
Emphysema is a chronic (long-lasting) disease that gradually destroys the lungs. The damage makes it hard to breathe. You have trouble breathing out carbon dioxide, and eventually you become unable to breathe in enough oxygen.
How does it occur?
Emphysema is one of the 2 main types of COPD: chronic bronchitis (inflamed airways) and emphysema (damage to the lung tissue). Chronic bronchitis and emphysema result from irritation of your airways over a long time, usually from smoking and sometimes from air pollution. Other causes are on-the-job exposure to irritants such as dust or chemicals, or frequent lung infections.
Cigarette smoking is the main cause of emphysema. The smoke damages the cells in your lungs. As the air sacs (alveoli) in your lungs become damaged, it gets harder for you to breathe out carbon dioxide after you breathe in. This means more carbon dioxide stays in your lungs and you have less room for oxygen when you breathe in. The damage to the lungs does not go away. Eventually you cannot breathe in enough oxygen to meet the needs of your body. About 15 to 20% of smokers (1 in every 5 or 6) develop emphysema. Unfortunately, you will not start having symptoms until serious damage has been done already.
An inherited disorder (passed down from parents) called alpha-1 antitrypsin deficiency (also called A1AD), can also cause emphysema. Alpha-1 antitrypsin (also called A1AT, AAT or alpha-1 proteinase inhibitor) is a substance that is made in the liver. The liver releases this substance into the bloodstream. It helps protect the lungs against damage from other chemicals in the blood. Having alpha-1 antitrypsin deficiency means that you don't have enough A1AT and your lungs can be damaged more easily. If you are a smoker AND have this genetic disorder, the lungs become damaged more quickly. Smokers with A1AD can develop emphysema in their 30s or 40s.
Sleep apnea is a serious sleep problem. If you have it, you stop breathing for more than 10 seconds at a time many times while you sleep. Another term for this problem is obstructive sleep apnea.
Sleep apnea affects between 2 and 10% of people. It is more common in men than in women. It is also more common in people who are overweight, but there are many people with normal weight who have sleep apnea.
How does it occur?
During normal sleep, throat muscles relax. In some people the airway can get blocked when this happens. The blockage slows or stops the movement of air, and the amount of oxygen in your blood drops. The drop in oxygen causes the brain to send a signal for you to wake up so that you can start breathing again. This cycle of not breathing and then waking up to breathe again may happen as often as 50 or more times an hour. Generally you will not remember waking up but the many arousals will make you sleepy the next day.
Being overweight may cause a narrowing of your airway. Other possible causes of sleep apnea are:
- tobacco smoking
- drinking a lot of alcohol
- lung disease
- an abnormal sleep pattern because of an irregular work schedule or rotating shift work.
Some people inherit a tendency to have sleep apnea.
Some tests performed by your pulmonologist
What are pulmonary function tests?
Pulmonary function tests (PFTs) measure how well your lungs take in and exhale air and how efficiently they transfer oxygen into the blood. There are several different tests:
- Spirometry measures how well the lungs exhale (breathe out).
- Lung volume measures how well the lungs inhale (breathe in).
- Tests of the diffusion capacity for carbon monoxide (DLCO) show how efficiently the lungs can transfer a gas into the bloodstream.
Why are these tests done?
Pulmonary function tests help:
- diagnose diseases of the lung such as asthma, chronic bronchitis, and emphysema
- determine the cause of shortness of breath
- measure the effects of exposure to chemicals, coal dust, and other toxins on your lung function
- measure the effectiveness of medicines and other treatments.
PFTs can help detect lung disease at an early stage, before you have symptoms.
How is the test done?
- Spirometry. You breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer measures the volume of air that you can force out of your lungs in 1 second after having inhaled as much air as you can. You will be asked to hold the tube of the spirometer in your mouth, breathe in as much air as possible, and then blow out as hard as you can into the spirometer for 1 second. The amount of air you can force out is called your forced expiratory volume, or FEV1.
- Sometimes, you will be asked to do this test before and after using an inhaled medicine. The medicine is called a bronchodilator. It helps open up small airways.
- Lung volume. For this test, you breathe nitrogen or helium gas through a tube for a certain amount of time. Then the concentration of the gas in a chamber attached to the tube is measured.
- Diffusion capacity. You breathe carbon monoxide for a very short time (often 1 breath). The concentration of carbon monoxide in the air you exhale is then measured. The difference in the amounts of carbon monoxide inhaled and exhaled shows how well gas can travel from your lungs into the blood.
PFTs are not painful, and you will have time to rest between the different breathing tests. The tests may be repeated 2 or more times.
What is a bronchoscopy?
A bronchoscopy is a procedure in which your healthcare provider examines the airways to your lungs with a thin, flexible, lighted tube called a bronchoscope.
When is it used?
This procedure may be done because:
- You have an irritation, growth, or scar tissue in part of your lungs or the airways to the lungs.
- There may be an inherited deformity in the lungs.
- There may be a foreign body, such as a peanut or coin, in your lungs.
- You may need your airways checked for signs of cancer.
- You have a cough or you are coughing up blood.
- You need to have cultures taken to diagnose an infection.
- You need to have a small sample of lung tissue (biopsy) taken for lab tests.
What happens during the procedure?
You are given a local or general anesthetic. A local anesthetic may be sprayed into your nose and mouth to prevent gagging when the tube is passed through your mouth. If you have a local anesthetic, you may also be given a sedative to relax you. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain. Your healthcare provider will pass a tube into your mouth and throat, down the windpipe, and into the lungs. If your provider finds cancer cells, growths, sores, or other unhealthy tissue, he or she may remove them or take a sample. If a foreign body is found, it is usually removed.