Pulmonary Medicine

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Pulmonary Medicine

 The Department of Pulmonary Medicine provides the highest quality care for patients with all types of lung disease.

Our goal is to provide personal care to every patient in a friendly, timely and accessible manner. The Pulmonary Medicine Department consists of specialists who care for both inpatients and outpatients with a variety of lung conditions.

You can take comfort in knowing that both your lung condition and your medical concerns will be addressed by one of our highly trained pulmonologists. For more information about services provided by the Pulmonary Medicine Department, please call (609) 893-1200 extension 5708.

Pulmonary Inpatient Services

Pulmonary patients admitted to Deborah Heart and Lung Center receive exceptional care from experienced and caring staff. Our nurse-to-patient ratios are much lower than area hospitals, providing time for individual care and patient education. Patient satisfaction surveys are frequently returned with comments about the excellent and courteous care received from nurses, nursing assistants, physicians, therapists and technicians during stays at Deborah Heart and Lung Center.

At Deborah, healthcare is all about caring. Direct admissions are typically scheduled through our Patient Access department following telephone contact with referring physicians or after outpatient visits.

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Outpatient Pulmonary Rehabilitation

Pulmonary rehabilitation is a program of exercise, education, and psychosocial support for persons with chronic lung disease. Deborah’s Outpatient Pulmonary Rehabilitation Program relies on a team of respiratory, physical, and occupational therapists working under the medical direction of Andrew Martin, MD, and Technical Director John Hill, RRT. Each patient receives a specially-designed personal plan that includes a combination of education, training, and exercises which the patient performs—with or without oxygen—under the supervision of a personal training team, two to three times a week for two to three months.

Patients can be referred to the program by a physician or by self referral. All patients will be scheduled for an appointment prior to initiating a care plan by the Medical Director of the program.

Pulmonary Rehabilitation is designed for individuals who have:

  • Lung Disease Asthma, COPD, Emphysema, Chronic Bronchitis
  • Shortness of Breath
  • Pulmonary Hypertension
  • Restrictive Lung Disease (Sjogren’s, Rheumatoid Arthritis, Asbestosis)
  • Trauma-Related Injury to the Lungs
  • Sarcoidosis, Bronchiectasis
  • Lung Cancer
  • Sleep Apnea
  • Pulmonary Fibrosis
  • Cystic Fibrosis
  • After lung surgery
  • Potential transplant candidates
  • Post-transplant candidates

Benefits of Pulmonary Rehabilitation

Shortness of breath limits activities of people with lung disease. Pulmonary Rehab helps improve the health of people living with a chronic lung disease. Benefits include:

  • Improved ability to perform daily activities
  • Increased knowledge of lung disease and how to manage symptoms
  • Increased self-esteem and confidence
  • Improved adherence to healthy lifestyle choices
  • Reduced anxiety

Breathe NIOV™ in Use for Pulmonary Rehabilitation

Deborah is proud to be the first hospital in South Jersey to implement the Breathe Non-Invasive Open Ventilation (NIOV™) System in its Pulmonary Rehabilitation Department.

The Breathe NIOV System is designed to ventilate patients with respiratory insufficiency for increased mobility and ambulation. The NIOV System is a wearable, small, one-pound, battery-powered volume augmentation ventilator delivering both ventilation and supplemental oxygen, which works with a patient’s spontaneous breathing via a small, non-invasive open nasal pillows interface. During Pulmonary Rehabilitation, Deborah’s therapists, under the direction of John Hill, RRT, Director Respiratory Services, guide the patient’s volume delivery settings and choose from three activity levels. Research has shown that COPD patients using the Breathe NIOV System experience significantly improved performance in the standard six-minute walk test (6MWT) with lower dyspnea scores and reduced work of breathing.

The Breathe NIOV System is of particular benefit for South Jersey lung transplant recipients who can now conduct their pre and post-surgery rehabilitation closer to home at Deborah.

Breathe Easier

More than 35 million Americans live with chronic lung disease. Deborah Heart and Lung Center’s comprehensive Outpatient Pulmonary Rehabilitation Program is designed to help patients who struggle with these challenging diseases do what others take for granted—breathe freely.

Our Outpatient Pulmonary Rehabilitation Program offers customized plans to meet your individual needs with information, therapies and strategies that can help you breathe easier, allowing you to be more active and independent.

Asthma: An Inflammatory Process

Asthma is defined as a chronic inflammatory disorder of the airways characterized by:

  • Variable and recurring respiratory symptoms
  • Airflow limitation or obstruction
  • Bronchial hyperresponsiveness

Right symptoms, wrong diagnosis

Many diseases present with symptoms similar to those seen in asthma. Understanding whether airway inflammation is present can help rule out these conditions and support a diagnosis of asthma.

Examples of conditions with symptoms similar to those seen in asthma:

  • Chronic cough
  • Gastroesophageal reflux disease (GERD)
  • Vocal cord dysfunction
  • Bronchitis
  • Chronic obstructive pulmonary disease (COPD)

Nitric Oxide and allergic airway inflammation

During inflammation, higher-than-normal levels of Nitric Oxide (NO) are released from the epithelial cells of the bronchial wall. Nitric Oxide is frequently increased in some inflammatory processes, such as asthma. NIOX VERO measures Nitric Oxide (NO) in human breath. Measurement of FeNO by NIOX VERO is a quantitative, non-invasive, simple and safe method to measure the decrease in FeNO concentration in asthma patients that often occurs after treatment with anti-inflammatory pharmacological therapy, as an indication of the therapeutic effect in patients with elevated FeNO levels.

Reasons why your physician would want a FeNO measurement:

  • Assists in diagnosis
  • Aids in treatment
  • Assists in monitoring control and adherence

Chronic Obstructive Pulmonary Disease: COPD

COPD is a group of lung diseases that include chronic bronchitis and emphysema, most often caused by heavy smoking. COPD can also include chronic asthma, which is a hypersensitivity of the air passages in the lungs. Bronchitis, emphysema and asthma all have one thing in common, they limit the flow of air in and out of your lungs.

How Your Lungs Work
Breathing is your body’s way of getting oxygen to your blood. Normally, your lungs take in oxygen when you inhale fresh air and push our carbon dioxide. When you have COPD, movement of air into and out of your lungs is limited, and breathing becomes difficult.

How is COPD Treated?
COPD has no cure, but it can be treated. Your physician will work with you to develop a plan which may include medication, learning to breath better, exercising, controlling stress and quitting smoking. Following through on your treatment plan will make a difference in how you feel.

When You Have COPD
The normal flow of air is blocked by excess mucus and inflammation (chronic bronchitis), by collapsed airways (emphysema), or by tightening of the muscles around the airways (chronic asthma). As a result, you feel short of breath. You may also cough, wheeze, or feel weak.

COPD–Your Medical History
Your doctor first evaluates your lungs to diagnose your condition. They will take your medical history, do a physical exam and other tests to be done. Once a diagnosis has been made, a treatment plan will be developed to control your symptoms and help you feel better. You will be monitored on your treatment plan and changes will be made as needed.

To diagnose your condition, your doctor needs to know the truth about your symptoms, lifestyle, and your family’s medical history. You will be asked questions like:

  • Do you smoke?
  • Have you been exposed to pollutants or dusts?
  • Is there a family history of lung disease?
  • Do you have shortness of breath, coughing, wheezing, excess mucus,
  • chest discomfort, swollen ankles?

COPD–Your Physical Exam
Your doctor will give you a complete physical exam. It will include listening to your heart and lungs, examining your nose and throat and blood tests, a chest x-ray, and an EKG to rule out heart disease as the cause of your shortness of breath.

Pulmonary Function Tests
Your doctor will also order one or more pulmonary function tests. These tests measure how much air you can take into your lungs and how fast you can blow air out (spirometry), how much air you exhale and how much air is left in your lungs after you exhale (lung volumes), and how much oxygen is transported from your lungs to your blood (lung diffusion). These tests are done in the doctors office or the hospital lab.

Other Tests
Your doctor may also order other tests to help diagnose lung disease including pulse oximetry to measure the level of oxygen in your blood at rest and after exercise, a blood gas test to measure the amounts of oxygen and carbon dioxide in your blood, an exercise treadmill test to see how well your heart and lungs work under stress and a CT (computed tomography) scan to reveal the condition of your lungs.

Pulmonary Fibrosis

The symptoms of Pulmonary Fibrosis are important to know. These symptoms can vary from very mild–to very severe. Symptoms to be aware of include:

  • Shortness of breath which usually appears during exercise, progressing to shortness during rest.
  • Cough without sputum which is dry, irritating and persistent.
  • Clubbing (enlargement) of the fingertips: present in 10-15% of all people with fibrosis.
  • Velcro crackles, noises in the lungs that sound like opening or closing of velcro. Not every one has these noises.
  • Hypoxemia, which is a low amount of oxygen in the blood.

Causes of Pulmonary Fibrosis

  • Occupational/environmental exposure to asbestos, silica, metal dusts, bacteria, fumes animal dusts or gases.
  • Occupational related disease such as asbestosis, silicosis, Farmers Lung, Bird Breeder’s Lung.
  • Lung infections like TB and others.
  • Drugs may cause pulmonary fibrosis, consult your doctor about any medications that you are taking.
  • Connective tissue, collagen, vascular diseases such as rheumatoid arthitis, systemic sclerosis, genetic not as common.

Diseases that Cause Pulmonary Fibrosis
Sarcoidosis involves the growth of granulomas, or areas of inflammatory cells. This disease can attack any body organ, but is most often found in the lungs. The cause is unknown. Symptoms may include dry cough, shortness of breath, mild chest pain, tiredness, weakness, and weight loss. It is most common in young adults age 20-40 years old.

How Can My Doctor Tell if it’s Pulmonary Fibrosis?
Once a diagnosis has been made, a treatment plan will be developed to control your symptoms and help you feel better. You will be monitored on your treatment plan and changes will be made as needed. Early diagnosis is the key to successful treatment. Several ways for doctors to diagnose cases of pulmonary fibrosis include:

  • Patient history is the most important tool in diagnosis. It is taken to identify risk factors such as environmental and occupational factors, hobbies, legal and illegal drug use, arthritis, and immune system diseases.
  • Physical exam uses diagnostic tests such as chest x-rays, computed tomography (CT), resting and exercising pulmonary function tests, and blood tests to detect oxygen levels. These tests help rule out other possible lung diseases.
  • Bronchoalveolar lavage is used to identify any inflammatory processed in lung tissue and to rule out infections and malignancies (cancer) as a cause of the symptoms. This procedure involves the removal and examination of cells and proteins through lung washings from the lower respiratory tract.
  • Bronchoscopy is the examination of air passages of the lung for accuracy in diagnosis. This is done by placing a flexible tube with a light and an optical lens through the nose or mouth into the trachea and bronchi.
  • Lung Biopsy is a surgical procedure that removes a sample of lung tissue to establish a diagnosis. This will allow for a measurement of how much inflammation and fibrosis is present and how far the disease has advanced.

Can Pulmonary Fibrosis be Treated?
There is no cure for pulmonary fibrosis. The aim of treatment is to reduce inflammation and prevent more scarring.

Pulmonary Fibrosis Treatment

  • Corticosteroids are used to treat acute tissue inflammation.
  • Immunosuppressants are used to suppress the immune system. Some success in stopping the growth of the disease in some patients who only respond to unacceptably high doses of corticosteroids.
  • Penacillamine has helped a few patients who have not responded to other therapies.Oxygen therapy may be needed for patients with very low blood oxygen.
  • Oxygen therapy is decided by your doctor.
  • Regular exercise increases muscle strength and breathing ability, and improves strength.
  • Flu and pneumonia vaccine is recommended for patients who have any lung diseases in order to prevent infection.
  • Rehab, education and support groups are recommended to improve activity levels.

Pulmonary Hypertension

Pulmonary Hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. Pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance and heart failure.

According to the most recent classification, it can be one of five different types: arterial, venous, hypoxic, thromboembolic or miscellaneous. In most patients, pulmonary hypertension has an identifiable cause. Although there’s no cure, treatments can reduce the symptoms, which include shortness of breath.

Asbestosis

Asbestosis is scarring of the lungs. It’s a slow developing problem that may not show up for years. A person will have more and more trouble breathing because of scar tissue buildup. Damage is permanent and related to exposure to asbestos. Anyone who works around asbestos for years and doesn’t take precautions can develop asbestosis. Lung Cancer is responsible for the most asbestos related deaths. Your risk of lung cancer increases with the length of time you are exposed to asbestos, even more if you smoke.

Mesothelioma is a rare and fatal type of cancer. It attacks the linings of the chest or abdominal cavity. Low exposure to asbestos can cause mesothelioma.

Other cancers may sometimes be related to asbestos exposure, including cancer of the larynx, stomach, colon and esophagus. This is because the asbestos fibers may get into your gastrointestinal tract if you swallow mucus that contains asbestos from your lungs or if you swallow secretions that contain asbestos from your nose or mouth.

What are the Symptoms of Asbestos?
If you think you’ve been exposed to asbestos and are experiencing any of these symptoms alone or in combination, contact your doctor or a specialist in occupational medicine. The specialist will want to know what kind of jobs you’ve worked on in the past and for how long. They may want to do tests to see if any problems are developing or already exist.

  • Shortness of breath-increases over time
  • Coughing
  • Increased sputum
  • Weight loss
  • Chest pain
  • Hoarseness
  • Coughing up blood

How Do You Recognize Asbestos?
It is usually hard to tell if a material contains asbestos. Products that contain asbestos are most often not labeled. Getting information from the manufacturer can be difficult, especially if the material is old and you don’t know where it came from. If you have doubts, the safest thing to do is assume that the material does contain asbestos. This doesn’t always mean it’s dangerous, asbestos isn’t a health hazard until fibers are being released. By the time symptoms appear lung cancer may have already spread to other parts of the body. If you have asbestosis, a disease which cannot be cured, you may not have been aware of the symptoms for years! Prevention is the only way to stay healthy.

Protecting Workers from Asbestos
The federal government has been regulating asbestos for years, and most states have programs too. The EPA and Occupational Safety and Health Administration (OSHA) have taken an active role in protecting workers from asbestos. In 1989 the EPA banned asbestos products. There are state and federal regulations governing the way asbestos is handled, repaired or removed.

Important!
The symptoms of asbestos related lung disease may take years to show up. Even if you feel fine, don’t make the mistake of thinking that you don’t need to take precautions. By the time symptoms appear lung cancer may have already spread to other parts of the body. If you have asbestosis–a disease which cannot be cured, you may not be aware of the symptoms for years! Prevention is the only way to stay healthy.

Sarcoidosis

What is Sarcoidosis?
Sarcoidosis is a medical mystery. For the physician who is working on the scientific frontier, the disease can be a fascinating challenge. For the patient it can be a very serious illness, though rarely fatal. Most sarcoidosis patients do not even have any symptoms and probably never know they have the disease. It is not a contagious disease.

What are the Symptoms of Sarcoidosis?
Most patients have no symptoms at all. In pulmonary sarcoidosis, patients may have a dry cough, shortness of breath or mild chest pain. There can also be fatigue, weakness or weight loss. These symptoms are common in many other lung diseases so diagnosis may be difficult. In those cases where symptoms appear outside the lungs, one may get a scaly rash, red bumps on the legs, fever, soreness of the eyes and pain and swelling of the ankles.

How is Sarcoidosis Diagnosed?
Any of the symptoms listed in the previous section may lead a physician to consider sarcoidosis, which is initially diagnosed based on a physical examination, lab tests, pulmonary function studies and a chest x-ray. When enlargement of lymph glands in the center of the lungs is seen on x-ray, sarcoidosis may be suspected. To confirm the diagnosis, a biopsy is usually performed on any of the affected organs.

What Causes Sarcoidosis?
This is a big part of the mystery-no one knows. Some physicians believe sarcoidosis results from inhalation of an infectious or allergic substance from the environment. Others believe that the disease is a basic problem in alteration of the cellular immune system.

How is Sarcoidosis Treated?
In the majority of patients the disease spontaneously disappears and no treatment is necessary. Drugs called corticosteroids are the most important treatment used in fighting sarcoidosis. Some physicians prescribe steroids when there are no symptoms but just abnormalities seen on the chest x-ray or in the lung function measurements. Other physicians wait for symptoms to appear before prescribing corticosteroids.

Patients should follow their doctor’s directions. This can be a continuation of your normal lifestyle. When drugs are prescribed, they should be taken faithfully, just as the physician orders. It is particularly important that the sarcoidosis patient doesn’t smoke!