Pulmonary Care

Bronchiectasis is a disease in which the large airways in the lungs are damaged. This causes the airways to become permanently wider. These damaged air passages allow bacteria and mucus to build up and pool in your lungs, which results in frequent infections and blockages of the airways. Bronchiectasis can be present at birth, infancy or develop later in life.

What causes bronchiectasis?

Bronchiectasis is often caused by inflammation or infection of the airways that keeps coming back.

Sometimes it begins in childhood after having a severe lung infection or inhaling a foreign object. Breathing in food particles can also lead to this condition. Other causes of bronchiectasis can include:

• Genetic disease such as cystic fibrosis and primary ciliary dyskinesia
• Problems with the immune system (reduced ability to fight infections
• Past lung infections
• Problems with swallowing causing aspiration of feed or fluids into lungs

Symptoms of bronchiectasis

Symptoms develop over time. They may occur months or years after the event that causes the bronchiectasis. The most common symptom of bronchiectasis is cough, which is usually productive of sputum (phlegm). Other symptoms may include:

• Breath odor
• Coughing up blood (less common in children)
• Fatigue
• Paleness
• Shortness of breath that gets worse with exercise
• Weight loss
• Wheezing
• Low grade fever and night sweats

Exams and test for bronchiectasis include:

• Alpha-1 antitrypsin blood test
• Chest X-ray
• Chest CT
• Sputum Culture
• Complete blood count (CBC)
• Genetic testing, including sweat tests for cystic fibrosis and tests for other diseases
• Pulmonary function tests

COPD is a term that covers two types of chronic long-term diseases: emphysema and chronic bronchitis. With COPD, the airways in the lungs become swollen and partly blocked. This condition tends to worsen over time and although it cannot be cured, COPD can be treated and managed. The UT Health East Texas offers a wide variety of treatment options to help patients breathe better.

Emphysema damages the tiny alveoli (air sacs) at the tips of your lungs. Normally these air sacs stretch like balloons as you breathe in and out. Emphysema makes these air sacs stiff because they cannot stretch, air gets trapped inside. This makes it difficult for you to breathe in and can make you feel tired. Emphysema is a chronic lung condition in which the air sacs may be collapsed, destroyed, narrowed, overinflated, or stretched.

Over inflation of the air sacs is a result of a breakdown of the alveoli walls. It causes a decrease in respiratory function and breathlessness. Damage to the air sacs can not be fixed. Talk with your doctor to see if the Zephyr Endobronchial Valve treatment is right for you.

Chronic bronchitis makes your airways red, swollen and irritated. Glands in your airways make extra mucus (phlegm), which blocks some air from passing through. This makes you cough, cough up mucus and feel short of breath. Many people with COPD have both emphysema and chronic bronchitis.

Causes of COPD

The number one cause of COPD is smoking tobacco. If you smoke or used to smoke, you are at a higher risk of developing COPD. Other causes include:

• A rare genetic disorder called Alpha-1 antitrypsin deficiency
• Air pollution (dust or chemicals)
• Asthma combined with smoking
• Repeated lung infections during childhood
• Second-hand smoke
• Severe asthma

Symptoms of COPD include:

• Frequent coughing or wheezing
• Excess phlegm or sputum production is usually worse in the mornings
• Shortness of breath with activity
• Trouble taking a deep breath

How is COPD diagnosed?

COPD is diagnosed using a simple breathing test called spirometry, which requires you to blow air into a mouthpiece and tube attached to a machine. The machine then measures the amount of air you blow and how fast you blow it.

How is COPD treated?

Tobacco cessation is the most important aspect of treatment. Avoiding tobacco smoke and other air pollutants at home and at work.

In addition, the Zepyr Endobronchial Valve is an alternative breakthrough technique to achieve lung volume reduction using a minimally invasive approach. The Zephyr Endobronchial Valve is a FDA-designated for bronchoscopic treatment of patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation (CV). 

Other COPD treatments include:

• Lung transplant
• Medications via inhalers or nebulizers, such as corticosteroids or bronchodilators. These can help relieve the obstruction and relieve the symptoms of coughing or wheezing.
• Pulmonary rehabilitation. A personalized treatment program that teaches you how to manage your COPD symptoms to improve quality of life. Plans may include learning to breathe better, how to conserve your energy and advice on food and exercise.
• Supplemental oxygen from a portable oxygen tank may be needed if blood oxygen levels are low.

Patients with COPD should treat lung infections quickly to prevent worsening of the lung function. This can be achieved with antibiotics and keeping up with the recommended vaccines (flu and pneumonia).

Critical care medicine is the practice of multidisciplinary medicine with patients who have sustained, or are at risk of sustaining life threatening, single or multiple organ system failure due to disease or injury. Critical care medicine seeks to provide for the needs of these patients through immediate and continuous observation and intervention in order to restore health and prevent complications.

Interstitial lung disease (ILD) is an umbrella term used for a large group of diseases that cause pulmonary fibrosis, or scarring of the lungs. Lung scarring causes stiffness in the lungs, which makes it difficult to breathe and get oxygen into your bloodstream. Lung damage from ILD is often irreversible and gets worse over time.

Symptoms of interstitial lung disease

The most common symptom of ILD is shortness of breath. This is often accompanied by a dry cough, chest discomfort, fatigue and occasionally weight loss. In most cases, by the time the symptoms appear lung damage has already been done, so it is important to see your doctor immediately. Severe cases that are left untreated can develop life-threatening complications, including high blood pressure, heart or respiratory failure.

How is ILD diagnosed?

To diagnose ILD, your doctor will probably order a chest X-ray or CT scan to get a better look at your lungs. A lung function test may be used to measure your total lung capacity, which may have deteriorated due to the ILD. In more serious cases, and to diagnose a specific type of ILD, more invasive procedures may be needed, such as a bronchoscopy or a lung biopsy.

Treatment for ILD

Treatment for ILD varies depending on the type of ILD diagnosed and the severity. Lung damage from ILD is often irreversible and progressive, so treatment normally centers on relieving symptoms, improving quality of life and slowing the disease’s progression. Medications, such as corticosteroids, can be used to decrease inflammation in the lungs. 

Oxygen therapy is another common treatment because it helps deliver extra oxygen to make breathing easier and lessen complications from low blood oxygen levels, such as heart failure. Pulmonary rehabilitation may also be recommended to improve daily life by giving patients techniques to improve lung efficiency, improve physical endurance and offer emotional support. In the most extreme cases, people with ILD will be recommended for lung transplants.

Interventional pulmonology uses endoscopy and other tools to diagnose and treat conditions in the lungs and chest.

Our interventional pulmonology procedures include:

• Flexible bronchoscopy – During flexible bronchoscopy, a doctor advances a flexible endoscope (bronchoscope) through a person’s mouth or nose into the windpipe. The doctor advances the bronchoscope through the airways in each lung, checking for problems. Images from inside the lung are displayed on a video screen. The bronchoscope has a channel at its tip, through which a doctor can pass small tools. Using these tools, the doctor can perform several other interventional pulmonology procedures.
• Rigid bronchoscopy – During a rigid bronchoscopy, a long metal tube is advanced into a person’s windpipe and main airways. The rigid bronchoscope’s large diameter allows the doctor to use more sophisticated surgical tools and techniques. Rigid bronchoscopy requires general anesthesia (unconsciousness with assisted breathing), similar to a surgical procedure.
• Thoracentesis – To drain fluid from around the lungs, a doctor inserts a needle into the chest wall. A plastic catheter is advanced over the needle, which is then removed. The excess pleural fluid is suctioned out of the chest and the catheter is removed and discarded.
• Tracheotomy – A tracheotomy or a tracheostomy is an opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube and is commonly done in an operating room under general anesthesia. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Breathing is done through the tracheostomy tube rather than through the nose and mouth.

Please call us to learn more about our interventional pulmonology treatments.

Detecting lung cancer early and treating it surgically improves patients’ five-year survival rate to more than 70 percent. The rate drops to 15 percent when detected later.

UT Health East Texas offers a low-dose CT scan, which screens for lung cancer in smokers.

To qualify for the scan, you must meet these criteria:

• Be a current or former smoker.
• Be 55 to 77 years of age.
• Have a smoking history of at least 30 packs/years. One pack a day for 30 years, two packs a day for 15 years, etc.

The test utilizes a low-radiation CT scan without IV contrast and takes less than 10 minutes.

Lung-nodule scanning is available at UT Health East Texas facilities in Athens, Henderson, Jacksonville, Pittsburg, Quitman, and Tyler.

Detecting lung cancer early and treating it surgically improves patients’ five-year survival rate to more than 70 percent. The rate drops to 15 percent when detected later. UT Health East Texas offers a low-dose CT scan, which screens for lung cancer in smokers. The test utilizes a low-radiation CT scan without IV contrast and takes less than 10 minutes.

To qualify for the scan, you must meet these criteria:

• Be a current or former smoker.
• Be 55 to 77 years of age.
• Have a smoking history of at least 30 packs/years. One pack a day for 30 years, two packs a day for 15 years, etc.

Lung-nodule scanning is available at UT Health East Texas facilities in Athens, Henderson, Jacksonville, Pittsburg, Quitman, and Tyler.  To learn more or schedule an appointment, call UT Health East Texas Pulmonary Institute at North Campus Tyler at 903-877-7916.

You can also reach our specialists at UT Health East Texas Pulmonary Institute at S. Fleishel by calling 903-592-6901.

The UT Health East Texas lung nodule program was designed to gather a multidisciplinary team to provide expert evaluation, early diagnosis and timely treatment of nodules detected in the lung. Our healthcare specialists use evidence-based guidelines in their evaluations, which are customized for each patient. We provide specialized and coordinated patient care that results in improved clinical outcomes.

All lung nodules should be evaluated to determine if the mass is cancer, represents a precancerous condition or may be cancer spreading from another part of the body. Most nodules are not cancerous and can be traced to a number of benign conditions, including infections or scars. The nodule may have been in the lung for years without causing any symptoms. 

Initial evaluations may include:

• Diagnostic imaging
• Breathing test
• Evaluation by a lung specialist
• Plan for follow-up monitoring

Some patients may receive a periodic series of CT scans to monitor a growing nodule, which may indicate a possible cancer. The physician will take into account whether the patient is at higher risk for lung cancer.

Customized treatment

Each patient in the program receives optimal, customized treatment based on thorough examination by the UT Health East Texas multidisciplinary team of specialists. Patients are offered access to the latest clinical trials.

This program is designed to simplify the process for the patient, eliminating unnecessary office visits and duplicated procedures, while ensuring timely follow-up and optimal care.

Our team at the UT Health East Texas Pulmonary Institute

Experts from the UT Health East Texas Pulmonary Institute include diagnostic radiology, diagnostic pathology, medical oncology, thoracic surgery and radiation oncology. These experts collaborate to create the patient’s individualized care plan.

Hallmarks of the UT Health East Texas Lung Nodule Program include:

• Coordination of care with multiple specialists
• Management of follow-up visits
• On-site CT scanning with same-day interpretation
• Ongoing communication with referring physician
• Patient education
• Prompt scheduling of initial visit
• Timely assessment, diagnosis and recommendations

Pleural effusion is an abnormal buildup of fluid in the pleural cavity. The pleural cavity is the space between the lungs and the chest wall. The fluid builds up between the two layers of the pleura, which is a thin layer of tissue that covers the lungs and lines the chest wall. When pleural effusion is related to cancer or there are cancer cells in the fluid, it may be called malignant pleural effusion.

Causes of pleural effusions

Pleural effusion can be caused by cancer cells spreading to the pleura. It can also develop if cancer cells block or change the flow of lymph fluid in the pleural cavity.

The following cancers are more likely to cause pleural effusion:

• Breast cancer
• Cancer of unknown primary (CUP)
• Cervical cancer
• Hodgkin’s lymphoma
• Leukemia
• Lung cancer
• Melanoma
• Mesothelioma
• Non-Hodgkin’s lymphoma
• Ovarian cancer
• Sarcomas
• Stomach cancer
• Uterine cancer

Symptoms of pleural effusion

Pleural effusion may not cause any symptoms at first, or the symptoms may be mild. Symptoms of pleural effusion can vary depending on the amount of fluid and how quickly it builds up. They include:

• Anxiety
• Cough
• Fear of suffocation
• Fever
• Malaise, which is a general feeling of discomfort or illness
• Pain or a feeling of heaviness in the chest
• Shortness of breath or difficulty breathing, which is called dyspnea

If dyspnea gets worse when you lie down, it is called orthopnea. It might get better if you stand or sit up. Shortness of breath may lead to you being more tired than usual because it can wake you up at night.

Diagnosing and treating pleural effusion

Pleural effusion is usually diagnosed by physical exams, chest X-ray, or CT scans.

If your doctor confirms you have pleural effusion, your healthcare team will monitor you closely and suggest ways to treat it. Fluid often builds up again after it is removed, so you may need more than one treatment. 

You may be offered the following treatment options for pleural effusion:

• Cancer treatment
• Draining the fluid
• Medicine
• Surgery

Pneumonia is an infection that inflames your lungs’ air sacs (alveoli). The air sacs may fill up with fluid or pus, causing cough, fever, chills, and trouble breathing.

Pneumonia symptoms can vary from so mild you barely notice them to so severe that hospitalization is required. How your body responds to pneumonia depends on the type of germ causing the infection, your age and your overall health. 

The signs and symptoms of pneumonia may include:

• Confusion, especially in older people
• Cough, which may produce greenish, yellow or even bloody mucus
• Fever, sweating and shaking chills
• Loss of appetite, low energy, and fatigue
• Nausea and vomiting, especially in small children
• Rapid, shallow breathing
• Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
• Shortness of breath

How is pneumonia diagnosed?

Sometimes pneumonia can be difficult to diagnose, because the symptoms are so variable and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will ask questions about your medical history, do a physical exam and run some tests. If your doctor suspects you may have pneumonia, they will probably recommend some tests to confirm the diagnosis and learn more about your infection. 

Tests include:

• Blood tests
• Bronchoscopy
• Chest X-ray
• CT scan
• Pulse oximetry
• Sputum test

Pulmonary function tests (PFTs) are noninvasive tests that measure how much air your lungs can hold and how well you can let the air out of your lungs. Also called lung function tests, PFTs allow physicians to diagnose the existence and severity of lung diseases and also indicate how well lung treatments may be working.

PFTs are among the examinations offered at the Ralph and Mary Prince Pulmonary Center at UT Health North Campus Tyler on an outpatient basis. Pulmonary function tests include:

• 6 Minute walk testing for oxygen qualification: A standardized test that measures the distance a person can walk in six minutes on a flat surface while breathing room air. It helps assess functional capacity and determines whether supplemental oxygen is needed based on blood oxygen saturation levels during exertion.
• Arterial blood gas analysis: A diagnostic test that measures oxygen and carbon dioxide levels in arterial blood, along with pH balance, to evaluate lung function and acid-base status. It is commonly used in critical care settings to assess respiratory efficiency.
• Bronchoscopy: A procedure in which a thin, flexible tube with a camera is inserted through the nose or mouth into the lungs to examine airways, collect tissue samples, or remove obstructions. It is used for diagnosing lung diseases, infections, and airway abnormalities.
• Cardiopulmonary exercise test (CPET): Assesses how well the heart, lungs and muscles are working individually, and how these systems are working together. A CPET is a highly sensitive, non-invasive stress test.
• Compliance test: Diagnoses a variety of lung conditions by checking the stiffness or elasticity of the lungs with the aid of a balloon catheter.
• Echocardiography for assessment of pulmonary hypertension:
• Exercise challenge for airway reactivity: This test is similar to Methacholine Challenge but treadmill is used instead of a chemical.
• Fractional exhaled nitric oxide (FeNO): Assists in the diagnosis and management of a variety of lung diseases, especially allergic asthma. Nitric oxide produced in the breathing passages is a marker of allergic inflammation.
• Gas exchange tests (DLCO): Measures how much oxygen passes from the lungs to the blood, which is important in diagnosing many lung diseases.
• Inspiratory and expiratory muscle pressures (PI and PE max): Evaluate possible neuromuscular disease by gauging the pressures generated by the respiratory muscles.
• Lung volume measurements: Detects restrictive lung diseases that prohibit complete inhalation of air. Restrictive lung diseases may be caused by inflammation or scarring of the lung tissue or by abnormalities of the muscles or skeleton of the chest wall.
• Maximal voluntary ventilation (MVV): Measures the amount of air that can be inhaled and exhaled in one minute to assess the overall function of the respiratory system.
• Methacholine challenge tests: Requires the inhalation of a mist solution of the drug methacholine, which causes twitching in the airways of people who have asthma or asthma-like conditions. Changes that may occur in the lungs are monitored during the test and are reversed with albuterol, a drug normally used to treat asthma.
• Oxygen titration tests: Determines if a patient using oxygen at home is receiving the proper levels of oxygen and if continued oxygen therapy is needed.
• Spirometry: Helps diagnose obstructive lung diseases that cause resistance to exhaling, such as asthma and chronic obstructive pulmonary disease (COPD). Spirometry is one of the most common pulmonary function tests.

These tests are ordered to ensure your lungs are healthy enough to have certain treatments, and to get a baseline to use before you begin treatment. PFTs are usually done by a trained respiratory therapist. Several types of measurements are taken during testing, and abnormal results could suggest you have a lung problem or lung disease. 

The results of your PFT may affect the type of treatment you are offered. Your doctor will decide whether you need further tests, procedures, follow-up care, or treatment.

Patients with severe emphysema who consistently feel short of breath despite using COPD medications and/or oxygen may be candidates for the Zephyr Endobronchial Valve implant. This FDA-approved, minimally invasive device is proven to help patients breathe easier, be more active and energetic, be less short of breath, and enjoy a significantly improved quality of life compared to untreated patients.

How does the Zephyr Endobronchial Valve procedure work?

The one-time procedure is done during a bronchoscopy that requires no cutting or incisions. Your doctor will give you a moderate sedation to make you sleepy. Then a small tube with a camera, called a bronchoscope, will be inserted into your lungs through your nose or mouth. The doctor will place (on average) four tiny valves in the airways to block off the diseased parts of the lungs. These valves reduce hyperinflation, preventing air from being trapped in the diseased area of the lung and allowing healthier parts of the lung to take in more air. This results in patients being able to breathe easier. Patients treated have reported immediate relief.

You will stay in the hospital for approximately three nights of observation. After your procedure, you will continue to use any medication your doctor may have prescribed for your condition.

To see if the Zephyr Endobronchial Valve is right for you, please call 903-592-6901.