Pulmonary Care

Alpha-1 antitrypsin deficiency (alpha-1) is a hereditary condition that is passed on from parents to their children through genes. This condition may result in serious lung disease in adults and/or liver disease in infants, children and adults.

Alpha-1 occurs when there is a severe lack of a protein in the blood called alpha-1 antitrypsin (AAT) that is mainly produced by the liver. The main function of AAT is to protect the lungs from inflammation caused by infection and inhaled irritants such as tobacco smoke. The low level of AAT in the blood occurs because it cannot be released from the liver at the normal rate. This leads to a buildup of abnormal AAT in the liver that can cause liver disease.

Often, Alpha-1 can go undetected for years. It is diagnosed through a simple blood test. This condition can be treated, but it cannot be cured without a liver transplant.

Pulmonary symptoms of alpha-1 include:

• Shortness of breath
• Wheezing
• Chronic cough
• Sputum (phlegm) production
• Recurring chest colds

Alpha-1 symptoms related to the liver include:

• Eyes and skin turning yellow (jaundice)
• Swelling of the abdomen (ascites)
• Vomiting blood or passing blood in the stool

Testing for alpha-1 is fairly simple, quick and highly accurate. It is done through a blood test or a mouth swab test. People at risk for alpha-1 should be tested, because there are treatments and preventive measures that may slow the progression of the lung disease and help you take better control of your health.

Testing criteria for alpha-1 includes:

• Everyone with emphysema, chronic obstructive pulmonary disease (COPD) or chronic bronchitis should be tested for alpha-1
• People with bronchiectasis, newborns, children and adults with unexplained liver disease
• People with a family history of liver disease
• Blood relatives of a person diagnosed with alpha-1
• Anyone with panniculitis, a skin disease

Talk to your doctor about whether you’re experiencing symptoms of alpha-q, and whether or not you qualify for alpha-1 testing.

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 tests 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.

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.

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.

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.

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).

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.

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.

Cystic fibrosis (CF) is a chronic disease that affects the lungs and digestive system. A defective gene causes the body to make thick, sticky mucus that clogs the lungs and causes serious lung infections. CF also affects other organs of the body and can prevent the break down of food and absorption of important nutrients. About 30,000 children and adults in the United States are affected by CF.

Accredited care from a team of experts

Accredited by the Cystic Fibrosis Foundation, we are the premiere Cystic Fibrosis Center serving East Texas. Our center follows the stringent standards of the CF Foundation and uses approved guidelines for treatment.

The Cystic Fibrosis Center is also a member of the Cystic Fibrosis Foundation® Therapeutics Development Network – the largest CF clinical trials network in the world that brings together experts from across the country to evaluate the safety and effectiveness of new CF therapies through clinical studies.

Besides our pulmonologists, there are other healthcare professionals that are there for the patient’s journey. This care team may include a nutritionist, social worker, respiratory therapist, pharmacist and/or physical therapist. The CF clinic at UT Health North Campus Tyler is unique because treatment for all ages is in one location and the same team cares for patients throughout the different stages of life – from childhood to adulthood.

Our pediatric and adult services

UT Health North Campus Tyler is the only referral site in East Texas for a sweat test, the diagnostic test for CF. When results are positive, then patients are referred to our CF clinic for further testing, which includes a complete history check, physical exam and diagnostic studies.

We follow up with every patient diagnosed with cystic fibrosis, monitoring their growth, response to treatment, and any complications that might occur. These follow-up appointments occur every three months and can include:

• Physician assessments.
• Meeting with nutritionist and/or social worker.
• Laboratory testing.
• Annual blood work and chest x-rays.
• Pulmonary function testing.

To learn more or schedule an appointment, call 903-877-5271.

During a normal day, we breathe nearly 25,000 times, exposing our bodies to millions of microorganisms that populate the atmosphere. The bacteria, viruses and fungi that invade the lungs can cause common diseases like the flu or pneumonia. For those with a weakened immune system, these infectious organisms can also cause rare lung diseases like tuberculosis (TB) and mycobacterial infections that can be hard to diagnosis and also hard to treat.

Fighting infectious diseases

Our adult and pediatric infectious lung disease experts are nationally known for their advanced skill in treating rare and uncommon lung infections, including Mycobacterium Avium Complex (MAC) and TB. Though relatively rare, MAC causes serious and chronic lung infections, striking people who already have other lung diseases such as asthma, bronchiectasis, chronic bronchitis or cystic fibrosis. While TB may seem like a disease of the past, it kills more than a million people worldwide each year. Learn more about MAC research and treatment and discover our expertise in battling TB across nine states.

Conditions we commonly treat

• Actinomycosis
• Fungal infections of the lung
• Nocardiosis
• Nontuberculous mycobacteria
• Tuberculosis, including multi-drug resistant TB

To learn more or schedule an appointment, please call us.

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 (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.

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.

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
• Patient education
• Prompt scheduling of initial visit

Mycobacterium avium complex (MAC) is an infection caused by a group of bacteria. Mycobacterium avium complex (MAC) is the most common form of nontuberculous mycobacteria (NTM). MAC accounts for more than 80% of all NTM lung disease cases in the U.S.

Symptoms of mycobacterium avium complex lung disease (MAC)

• Cough – You may or may not cough out sputum. NTM lung disease may cause you to cough up blood (this is called hemoptysis). If you cough up blood, you should contact your doctor or seek emergency help immediately. Any time you cough up blood, it is essential that you remain calm and still to help minimize the amount of blood you cough.
• Loss of weight – It is not uncommon to lose weight, which is why it is important to be aware of weight changes. Please consult with your doctor and/or a nutritionist to determine how to modify and augment your diet. You can also find a nutrition guide with suggestions for increasing caloric intake, as well as a printable food diary at ntminfo.org.
• Night sweats – The sensation of feverishness and sweating is often more prominent at night.
• Fatigue
• Chronic cough
• Shortness of breath

Treatment for mycobacterium avium complex lung disease (MAC)

If you are diagnosed with MAC lung disease, you will work with your doctor to make decisions about your treatment options. Because MAC can be challenging to get rid of you should consider finding a pulmonologist or infectious disease specialist with experience treating people with NTM lung disease.

Treatment of MAC lung disease varies from person to person. Not everyone who is diagnosed with MAC lung disease needs to begin treatment right away. Some localized infections are very slow-growing and may or may not progress. If that is the case, your doctor might recommend a watchful waiting period before starting treatment. You would then be monitored with regular follow-up exams to catch any change in your condition before it causes further damage to your lungs.

The standard treatment for most MAC infections is a combination of two or more antibiotics taken over many months. The specific drugs you are prescribed will depend on whether or not the organism has developed any antibiotic resistance. The progress of your treatment will be monitored by collecting follow-up sputum samples. Your disease will only be considered cured when your samples show no sign of MAC infection for at least 12 months. This is to help make sure that your disease does not come back.

Managing mycobacterium avium complex lung disease (MAC):

Taking care of your lungs is critically important to your recovery, especially if you also have bronchiectasis, COPD or another chronic lung disease. Some proven-effective recommendations are:

• Airway clearance techniques are used to reduce the mucus buildup in your lungs and airways. This helps prevent new infections, reduce uncontrolled coughing and improve breathing ability. Chest physical therapy, nebulized hypertonic saline, postural drainage, oscillation vests, chest percussion devices and controlled “huff” coughing can all be used to thin, loosen and expel thick mucus.
• Preventing infections through good hygiene and regular immunizations against influenza and pneumonia, both of which can cause severe complications for people living with NTM and other lung diseases.
• Avoiding exposure to smoke and other lung irritants helps to reduce inflammation that can worsen lung disease. If you are a smoker it is especially important that you quit as soon as possible.
• Other healthy behaviors that will help you manage your MAC disease include:
  • Exercise to build your endurance, strengthen your breathing ability and lift your mood.
  • A well-balanced diet to help you maintain a healthy weight and get the nutrients you need to fight your infection.

How to become a new patient

Your primary care physician, pulmonologist or infectious disease physician can refer . Please fax the following information to the referrals department at 903-877-8919.

1. Results of sputum cultures for AFB (including the first positive AFB and the last two years of cultures for AFB).
2. Results of susceptibility tests on positive AFB cultures, if available.
3. Results of routine sputum cultures from the past 12 months, if available.
4. Clinical or physician notes (or medical records) that describe your drug treatment, results of bronchoscopy or chest CTs.
5. Face – sheet – Demographics and Insurance card.

The patient should bring (preferably on a CD) the following documents to their clinic appointment. The most current CT scans of the chest (within the last 6 months) with written interpretive reports.

Nontuberculous mycobacteria (NTM) are naturally occurring environmental organisms found widely in both water and soil. They can cause or worsen significant respiratory damage, such as bronchiectasis. There are more than 180 species of nontuberculous mycobacteria. Mycobacterium avium complex (MAC) is just one of the many species.

Symptoms of nontuberculous mycobacteria lung disease (NTM)

Patients with NTM infections often experience a variety or even all of the following:

• Cough – You may or may not cough out sputum. NTM lung disease may cause you to cough up blood (this is called hemoptysis). If you cough up blood, you should contact your doctor or seek emergency help immediately. Any time you cough up blood, it is essential that you remain calm and still to help minimize the amount of blood you cough.
• Night sweats/fever – You may experience some low-grade fever. The sensation of feverishness and sweating is often more prominent at night.
• Loss of weight and loss of appetite – It is not uncommon to lose weight, which is why it is important to be aware of weight changes. Please consult with your doctor and/or a nutritionist to determine how to modify and augment your diet. You can also find a nutrition guide with suggestions for increasing caloric intake, as well as a printable food diary, at ntminfo.org.
• Lack of energy – Many patients note a variable but often profound sense of fatigue.
• Feeling short of breath
• Wheezing
• Chest pain around the lung area

Treatment for nontuberculous mycobacteria lung disease (NTM)

Some species of nontuberculous mycobacteria lung disease are readily treated with two or three drugs, while other types are resistant to many drugs and more difficult to treat. These require treatment that is often more complex and of a longer duration.

How to become a nontuberculous mycobacteria lung disease (NTM) patient

Your primary care physician, pulmonologist or infectious disease physician can refer. Please fax the following information to the referrals department at 903-877-8919.

1. Results of sputum cultures for AFB (including the first positive AFB and the last two years of cultures for AFB).
2. Results of susceptibility tests on positive AFB cultures, if available.
3. Results of routine sputum cultures from the past 12 months, if available.
4. Clinical or physician notes (or medical records) that describe your drug treatment, results of bronchoscopy or chest CTs.
5. Face sheet, demographics and Insurance card.

The patient should bring to their clinic appointment their most current CT scans of the chest (within the last 6 months), preferably on a CD with written interpretive reports.

It’s not uncommon for babies, children and teens to experience lung or breathing problems as their bodies grow and develop. Symptoms of respiratory complications can include chronic cough, difficulty breathing, recurring pneumonia or lung infections and noisy breathing. Children suffering from chronic respiratory or breathing problems are often referred to a physician who is expertly trained in pediatric pulmonary medicine.

The UT Health East Texas Pulmonary Institute at UT Health North Campus is home to the region’s only board-certified pediatric pulmonologist and pediatric sleep medicine physician, Rodolfo Amaro Galvez, MD. Dr. Amaro Galvez and his clinical staff have the expertise in caring for children — from infancy to age 18 — with breathing problems. We offer a full range of diagnostic testing and treatment so children can breathe easier.

Lung conditions we commonly treat include:

• Asthma
• Chronic lung disease
• Chronic cough and wheeze
• Congenital lung and airway conditions
• Cystic fibrosis
• Recurrent pneumonia
• Respiratory insufficiency
• Unusual respiratory infections

Testing and procedures we perform:

• Bronchoscopy
• Oxygen and carbon dioxide monitoring
• Pulmonary function testing (PFT)
• Sleep studies offered at UT Health East Texas Sleep Disorder Centers
• Sweat testing for cystic fibrosis
• Thoracentesis
• Exhaled Nitric Oxide (FeNo)

To learn more or schedule an appointment, call 903-877-5271.

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 include cancer treatment, draining the fluid, medication, and surgery.

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

What are the symptoms of pneumonia?

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 germ causing the infection, your age and your overall health. The signs and symptoms of pneumonia may include:

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

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. These may include:

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

Primary ciliary dyskinesia (PCD) is an inherited disorder that causes life-long respiratory tract infections, shortness of breath and ultimately, permanent damage to lung function and other organs. The fundamental cause of this disease is that “cilia” (tiny, hair-like structures that line the nasal passages, sinuses, inner ears and lung) do not function normally to process mucus. The processing of mucus is a crucial biologic system known as mucociliary clearance. Defects in mucociliary clearance can lead to profound illness.

The Primary Ciliary Dyskinesia (PCD) Foundation was developed to improve the quality of life in people affected by PCD. The mission of the PCD Foundation is to promote research, increase public awareness and provide information and support services for individuals with PCD and their caregivers. A primary goal of the PCD Foundation is access to high-quality diagnostic and treatment for all individuals with PCD. The University of Texas at Tyler Health Science Center is proud to be a PCD Center of Excellence. There, patients can undergo the best PCD specific testing and management. PCD patients can be assured of getting the most up to date treatment and will have the opportunity to participate in national treatment trials. The PCD Center at The University of Texas at Tyler Health Science Center is made up of multi-disciplinary specialties including pulmonology, respiratory therapy, otolaryngology and audiology.

The University of Texas at Tyler Health Science Center joins the PCD Foundation in its ultimate goal of finding a cure for primary ciliary dyskinesia. In working to accomplish this goal, we provide the highest level of care and expertise for our patients affected by PCD.

Symptoms of primary ciliary dyskinesia (PCD):

PCD mainly affects the sinuses, ears and lungs. One sign that you might have PCD is if you have chronic (ongoing) infections in one or more of these areas. Common signs, symptoms and complications linked to PCD include the following:

Sinuses:

• Chronic nasal congestion.
• Runny nose with mucus and pus discharge.
• Chronic sinus infections.

Ears:

• Chronic middle ear infections.
• Hearing loss.

Lungs:

• Respiratory distress (breathing problems) in newborns.
• Chronic cough.
• Recurrent pneumonia.
• Collapse of part or all of a lung.

PCD also can cause fertility problems in men and women. In men, PCD can affect cilia-like structures that help sperm cells move. Because the sperm cells don’t move well, men who have the disease usually are unable to father children.

Fertility problems also occur in some women who have PCD. These problems likely are due to faulty cilia in the fallopian tubes.

Treatment for primary ciliary dyskinesia (PCD):

Currently, there is no cure for primary ciliary dyskinesia. The ultimate treatment goal in patients with PCD is to slow the progression of the disease. Doctors will also try to maintain airway health and treat lung and upper airway conditions. Current treatment includes:

• Treating sinus and ear infections with saline nasal washes, anti-inflammatory nasal sprays and nasal/sinus surgery.
• Preventing and delaying progressive and/or advanced lung diseases with airway clearance, bronchodilators, mucolytics, antibiotics and steroids.
• Monitoring airway health with sputum cultures, bronchoscopy, imaging, and pulmonary function testing.

To learn more or schedule an appointment, please call us.

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.

Tuberculosis (TB) is a contagious disease caused by mycobacterium tuberculosis bacteria (Mtb). It is spread through the air when a person with TB coughs, speaks or sings, and people nearby breathe in these bacteria and become infected.

Types of tuberculosis 

A TB infection doesn’t always mean that person will get sick. There are two forms of the disease:

• Latent TB – The germs are present in the body, but the immune system keeps them from spreading. The person may not have any symptoms and is not contagious. However, the infection is still alive and can one day become active. If the person is at high risk for re-activation for instance, if they have HIV, have had an infection in the past two years, chest X-ray is unusual or immune system is weakened. They should consult their doctor about medications to prevent active TB.
• Active TB – The germs multiply and make the person sick. The infected person can spread the disease to others. Ninety percent of active cases in adults come from a latent TB infection.

Symptoms of tuberculosis 

Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause symptoms such as:

• A bad cough that lasts three weeks or longer.
• Pain in the chest.
• Coughing up blood or sputum (phlegm from deep inside the lungs).

Other symptoms of TB disease are:

• Weakness or fatigue.
• Weight loss.
• No appetite.
• Chills.
• Fever.
• Sweating at night.

Symptoms of TB in other parts of the body depend on the area affected. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others.

Treatment for tuberculosis

When TB bacteria become active (multiplying in the body) and the immune system can’t stop the bacteria from growing, this is called TB disease. TB disease will make a person sick. People with TB disease may spread the bacteria to people with whom they spend many hours.

It is very important that people who have TB disease are treated, finish the medicine and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again. If they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

TB disease can be treated by taking several drugs for six to nine months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are:

• Isoniazid (INH)
• Rifampin (RIF)
• Ethambutol (EMB)
• Pyrazinamide (PZA)

How is tuberculosis diagnosed?

A skin test and/or a blood test can tell if you have tuberculosis.

For a skin test, you will have a small amount of non-infectious tuberculosis protein injected under the skin of your arm. This protein cannot spread the disease.

It can take two to three days for your skin to react to the injection for a positive result. If it is positive, you will need more tests to find out if you have the latent or active form of tuberculosis. This may include:

• Medical examination
• Chest X-ray
• Testing of some of your phlegm (thick liquid that comes up from your lungs or airways)

Tuberculosis treatment

Tuberculosis can be cured by taking antibiotics. See your healthcare provider for treatment options. It is important for you to take all of your antibiotics as prescribed to avoid spreading pulmonary tuberculosis to others.

To learn more or schedule an appointment for an adult with TB, call 903-877-7916.

To learn more or schedule an appointment for an pediatric patient with TB, call 903-877-5271.