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

UT Health cardiopulmonary and pulmonary rehabilitation programs help people return to their daily lives with the training necessary to manage their conditions. Physicians, registered nurses, respiratory therapists, exercise physiologists and trainers work together to deliver the appropriate care for each individual.

Cardiac rehabilitation 

Monitored exercise, education and physician supervision come together to promote lifestyle change for people diagnosed with cardiac conditions such as angina, coronary artery disease, congestive heart failure or heart attack. Through this program, individuals receive the information they need to take control of their heart health so that they may safely participate in activities of life with confidence.

UT Health Rehabilitation Center in Tyler is the first in East Texas to offer Pritikin ICR. Click the link to learn more about the differences between traditional vs. intensive cardiac rehabilitation.

Pulmonary rehabilitation

Respiratory therapists play a crucial role in helping patients who suffer from chronic lung conditions. We aim to enhance your quality of life and promote a more productive lifestyle. Our pulmonary rehabilitation program involves several key strategies. 

First, monitored exercise programs are tailored to each individual’s capabilities and health status. Exercise will help to improve your respiratory function and overall physical fitness. Disease education is another vital component, empowering patients with in-depth knowledge about their condition and how to manage symptoms more effectively.

Breathing retraining techniques are also taught to improve lung efficiency and alleviate respiratory discomfort. Proper medication usage is another focus area to help control symptoms and prevent flare-ups. Additionally, therapists advise patients on the use of adaptive equipment and oxygen therapy, which are essential for some patients in maintaining optimal lung function and managing their condition day-to-day. 

Ultimately, our pulmonary rehabilitation program aims to enable patients with chronic lung issues to lead fuller, more active lives while effectively managing their health.

Rehabilitation program referrals or inquiries can be made by calling 903-596-3000 or 1-800-338-7293.

COPD is a term that covers two types of chronic long-term diseases where the airways in the lungs become swollen and partly blocked. COPD gets worse over time. COPD cannot be cured, but it can be treated and managed. The UT Health East Texas Pulmonary Institute offers a wide variety of treatment options to help patients breathe better.

COPD consists of two major breathing diseases: emphysema and chronic bronchitis

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
• 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 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:

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

Symptoms of COPD

• 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.
• Zephyr 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).
• Medications via inhalers or nebulizers, such as corticosteroids or bronchodilators, that will 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.
• Avoiding and treating 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).
• Supplemental oxygen from a portable oxygen tank may be needed if blood oxygen levels are low.
• Lung transplant referral.

Is COPD reversible?

Unfortunately, COPD is not reversible. However, with early diagnosis and prompt therapy, the disease can be managed. Please talk with your primary care provider if you or someone you know has any of the above symptoms.

To learn more or schedule an appointment, call:

UT Health East Texas Pulmonary Institute at North Campus Tyler at 903-877-7916

UT Health East Texas Pulmonary Institute at S. Fleishel – A department of UT Health Tyler at 903-592-6901

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, which means scarring of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. Lung damage from ILD is often irreversible and gets worse over time.

Symptoms of interstitial lung disease (ILD)

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 interstitial lung disease (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 interstitial lung disease (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.

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 services.

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. Pulmonary function tests are also called lung function tests.

How much air can your lungs hold? How quickly can you move air in and out? How well can your lungs take in oxygen and remove carbon dioxide from your blood? Pulmonary function tests provide answers to these questions. They allow physicians to diagnose the existence and severity of lung diseases and also indicate how well lung treatments may be working. Same-day testing is available.

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 walking test for oxygen qualification
• Arterial blood gas analysis
• Bronchoscopy
• Cardiopulmonary exercise test (CPET) – Assesses how well the heart, lungs and muscles are working individually, and how these systems are working in together. A CPET is highly sensitive, non-invasive stress test. 
• Compliance test – Diagnose a variety of lung conditions by checking the stiffness or elasticity of the lungs with the aid of a balloon catheter.
• Exercise challenge for airway reactivity (similar to Methacholine Challenge but treadmill is used instead of a chemical)
• Echocardiography for assessment of Pulmonary Hypertension
• 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) – Measure 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 – Detect 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 – Require 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 – Determine if a patient using oxygen at home is receiving the proper levels of oxygen and if continued oxygen therapy is needed.
• Spirometry – Diagnoses 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.

Pulmonary function tests may be done to make sure that your lungs are healthy enough to have certain treatments, or to get a baseline to use before you begin new medications. Pulmonary function tests are usually done by a trained respiratory therapist. Tell your provider about all prescription and non-prescription medicines you are taking, including ones for breathing problems.

What do pulmonary function test results mean?

Several different types of measurements are taken during pulmonary function testing. The results tell your healthcare team how well your lungs are working. Abnormal results could suggest that you have a lung problem or a lung disease such as:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Heart failure
• Loss of lung tissue
• Scarring of the lung tissue (pulmonary fibrosis)

What happens if a change or abnormality is found?

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

The first FDA-approved, minimally-invasive device available in the United States for treating patients with severe emphysema.

Who is the Zephyr Endobronchial Valve for?

Patients with severe emphysema who consistently feel short of breathe despite using COPD medications and/or oxygen are candidates for the Zephyr Endobronchial Valve implant. 

What are the benefits of Zephyr Endobronchial Valve?

Patients report being able to take full breaths immediately after the procedure and within a few days are back to doing everyday tasks with ease. In clinical studies, patients treated with Zephyr Endobronchial Valves have been shown to:

• Breathe easier
• Be more active and energetic
• Be less short of breath
• 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. During the procedure, on average four tiny valves are placed in the airways to block off the diseased parts of the lungs. The 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.

What can patients expect?

A typical Zephyr Endobronchial Valve procedure looks like this:

• The doctor will give you moderate sedation to make you sleepy.
• A small tube with a camera, called a bronchoscope, will be inserted into your lungs through your nose or mouth.
• During the procedure, on average the doctor will place four Zephyr® Endobronchial Valves in the airways.
• You will stay in the hospital for approximately three nights for observation.
• After the procedure, you will continue to use the medicines that your doctor has prescribed for your condition.

How do I schedule a consultation to see if I am a candidate for the Zephyr Endobronchial Valve?

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