Pulmonary care services in East Texas

Advanced lung and pulmonary care in East Texas

At the UT Health East Texas Pulmonary Institute, our expert pulmonologists and lung disease specialists are dedicated to providing advanced pulmonary care services. Our facilities are equipped to handle everything from common lung conditions like bronchitis and asthma to rarer lung diseases that require more specialized care. We pride ourselves on being the largest team in the region, offering comprehensive respiratory treatments, urgent lung care, sleep medicine, allergy diagnosis and treatment, pediatric pulmonology, and interventional pulmonology. If you’re experiencing respiratory health issues, don’t hesitate to reach out. Contact us today to learn more about our lung treatment centers or to book your next appointment with one of our skilled lung care specialists.

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Our pulmonary care services

Our team includes board certified pulmonologists and registered respiratory therapists trained to help people with lung problems on an emergency, inpatient or outpatient basis. They regularly work with people on ventilators, especially in emergency or ICU settings, and provide breathing and nebulizer treatments.

We offer clinics as well as diagnostic testing and imaging throughout East Texas. Clinic locations include: Athens, Carthage, Gun Barrel City, Henderson, Jacksonville, Palestine, Pittsburg, Quitman and Tyler. Advanced procedures and surgeries are performed at UT Health Tyler.

Click below to explore our pulmonary care services.

Alpha-1 antitrypsin treatment

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 criteria for alpha-1

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.

The following people should test for alpha-1:

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 n People with a family history of liver disease.
Blood relatives of a person diagnosed with alpha-1.
Anyone with panniculitis, a skin disease.

Bronchiectasis 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

Cardiopulmonary rehabilitation

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.

Chronic obstructive pulmonary disease (COPD) treatment

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 services

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 treatment

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.

Besides our pulmonologists, there are other healthcare professionals that are there for the patient’s journey. Your 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.

Caring for East Texas

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.

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.

Infectious lung disease treatment

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 include:

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

Interstitial lung disease care

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 services

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.

Ion endoluminal system for lung nodules

If you or someone you know has been diagnosed with a suspicious lung nodule and want to know with certainty if it is benign or cancerous we want to share with you information about the Ion endoluminal system by Intuitive.

What is the Ion endoluminal system?

Ion is used to perform robotic-assisted bronchoscopy to take a closer and less invasive look at suspicious lung nodules. This system can reach all 18 segments of the lungs to obtain a biopsy. Ion allows for more precision, more reach and more answers.

The ultra-thin catheter and integrated vision probe provide our pulmonologist direct vision to reach all parts of the lungs. The shape-sensing technology provides precise location and shape information throughout the whole biopsy process. Ion allows our pulmonary physicians to perform needle aspiration in a non-invasive procedure rather than having to puncture the chest wall.

If you and your pulmonary physician decide that robotic-assisted bronchoscopy is right for you, then here is what happens:

Three-dimensional mapping: Ion begins with PlanPoint software, which uses a CT scan of the patient’s lungs to generate 3D airway trees. An interface that allows our pulmonary physicians to identify a target and create a pre-planned path to the lung nodule.
Navigation to lung nodule target: During the robot-assisted bronchoscopy with Ion, the pulmonary physician uses Ion’s controller to navigate to the target lung nodule via the pre-planned path. With Ion’s ultra-thin robotic catheter and advanced maneuverability, the physician can navigate far into the peripheral lung through the patient’s airway to the area of biopsy. The small and flexible catheter can reach all segments of the lung. Even areas far into the outer lung.
Lung nodule biopsy: Once at the target location of the nodule for biopsy, the catheter locks in place. The pulmonary physician will then insert biopsy tools through the catheter to take a sample of the patient’s lung tissue.

Talk with your physician to find out if you are a good candidate for the non-invasive lung nodule biopsy.

Lung cancer screening

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.

Lung nodule program

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.

Lung nodule testing

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:

Breathing test
Diagnostic imaging
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.

UT Health East Texas Pulmonary Institute multidisciplinary team

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

Please call us to learn more about our lung nodule program.

Mycobacterium avium complex

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.

Results of sputum cultures for AFB (including the first positive AFB and the last two years of cultures for AFB).
Results of susceptibility tests on positive AFB cultures, if available.
Results of routine sputum cultures from the past 12 months, if available.
Clinical or physician notes (or medical records) that describe your drug treatment, results of bronchoscopy or chest CTs.
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 lung disease care

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 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 NMT

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 an 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.

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

FAQ for NTM

Why do I need to have sputum cultures?

Sputum cultures tell you and your healthcare provider what kinds of germs might be in your lungs. Knowing which germs are present helps your healthcare provider choose the right treatment for your infection. Along with your symptoms, the provider will then determine if, and when treatment is needed. If you are not experiencing symptoms or worsening of symptoms, there is no need to contact your provider. It is important to keep in mind that the lungs are not sterile. People may have bacteria in their lungs but still be healthy and not require antibiotics.

How often does sputum need to be mailed?

Every three months if not currently on treatment otherwise every month.

Do I pay to mail sputum?

Yes, you are required to pay postage for USPS or any other carrier you choose, to deliver your sputum specimen. Tracking numbers can help you determine if it has been received but are not required.

How do I request more mailers?

When you mail your last container, send a request through MyChart or call 903-877-7916 and let us know you need a new supply. Three more containers will be mailed, and it usually takes 7-10 days. If you haven’t received them in 2 weeks, let us know.

Why can I not see my results?

When the results are finalized, they will appear in MyChart. You will not see preliminary results.

Why can I not see sensitivities?

Epic does not display sensitivities in MyChart but your provider can see them.

How do I read my sputum culture?

Not all positive cultures have the same significance or meaning. Any positive culture must be interpreted by considering factors such as patient symptoms, chest x-rays, and chest CT scan findings. A positive culture does not mean treatment is failing or has failed, or that treatment should be restarted if it has been stopped. These considerations usually require discussion with the provider during your next scheduled appointment.

Colonization – Indicates the presence of an organism without symptoms of illness. The patient does not have symptoms when colonized. Individuals can be intermittently or permanently colonized.

Infection – Indicates the presence of an organism with clinical signs and symptoms of illness.

What if my culture does not grow anything?

No action is needed if you are not having symptoms. If you are having new or increased symptoms it could be an exacerbation of your lung disease rather than an infectious process and should be reported.

Do I need to continue my medications if I feel better?

Yes, stopping medications on your own could create resistance to antibiotics. Consult your provider prior to discontinuing medications.

What is resistance?

Resistance is a defense bacteria acquire against antibiotics. When bacteria become resistant, it means they have changed some of the physical traits that make them vulnerable to antibiotics.

When do I need an eye exam?

When starting treatment that could cause vision changes or anytime you experience changes in your vision during your treatment. Your ophthalmologist will determine how often you should have routine follow-up exams during your treatment course.

When prescribed Ethambutol you should see your ophthalmologist as soon as possible and let them know you are taking ethambutol. The ophthalmologist will then make the decision regarding how frequently the vision exams should be.

What if I notice changes in my vision?

Stop your medication immediately, make an appointment with your ophthalmologist and notify your care team right away.

When do I need a hearing test?

When starting treatment that could cause hearing loss or anytime you experience changes in your hearing during your treatment. Your audiologist will determine how often you should have routine follow-up exams during your treatment course.

When on Azithromycin or Aminoglycosides.

Samples of Aminoglycosides:

Amikacin
Arikayce
Tobramycin
Streptomycin

What if I have changes with my hearing?

Stop your medication immediately, notify your care team, and make an appointment with your audiologist.

How often do I need?

High Resolution chest CT scan: Once a year, as needed, depending on the current symptoms.
PFT: Pulmonary Function Test is required once a year. Spirometry is required at every follow up.
Lab Work: 1-3 months while on NTM antibiotics

Does my drug treatment interact with my other medications?

Follow up with your pharmacist with a complete list of all the medications you are taking as they have a better understanding of possible interactions.

How long do I take the antibiotics?

It varies depending on your condition, check with your care team before stopping treatment. The guidelines for NTM management recommended patients stay on therapy for 12 months after they have cleared the infection. Overall therapy plans depend on how well the bacteria responds to treatment, if it develops resistance, how well your immune system responds to the pathogen, and how well you are doing on the medications.

Respiratory Order of Therapy:

Please keep in mind all these steps might not apply to you specifically:

Bronchodilator such as albuterol to help open up the airways.
Hypertonic Saline (3-3.5%, 7% or 10% Sodium Chloride) to help wet secretions and mobilize them.
Airway Clearance with a vibration device such as Aerobika or a vest to help move secretions.
Active Cycle of Breathing to move secretions from the small airways to the large airways. This facilitates coughing up secretions.
Antibiotic treatment such as Arikayce, TOBI, or Gentamicin (if ordered) to help clear infection.

Should I exercise?

Exercise and staying active should be a part of everyone’s daily routine. Exercise does not have to be something formal that is done at the gym. Some benefits of exercise:

Keeps the lungs healthy
Loosens mucus in the lungs so it can be coughed up easier
Makes breathing deeper easier

Can I go on vacation/fly?

Yes, ntminfo.org has a printable card which notifies agents of any conditions or devices that would require special attention.

Do I have to do airway clearance when on vacation?

To prevent an exacerbation it is best practice to continue your whole treatment regimen even while on vacation. If this is not possible, reduce treatment to Aerobika and Active Cycle of Breathing until all treatment is possible.

What is an exacerbation?

A bronchiectasis exacerbation is if you have 3 or more of the following symptoms for more than 48 hours:

Increased cough
Increased mucus production
Color change of your sputum to green
Blood in your sputum
Chest discomfort
Fever

If you experience 3 or more of those symptoms for 48 hours then you should let me know because it would mean that you need an antibiotic.

Pediatric lung care

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 treatment

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

Diagnosis and treatment

If shortness of breath, or 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.

Pleural effusion is usually diagnosed by CT scan, chest X-ray, or physical exam. If 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 treatment

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

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 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 Health Science Center in Tyler is proud to be a PCD Center of Excellence.

At the University of Texas Health Science Center in Tyler, 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 Health Science Center in Tyler is made up of multi-disciplinary specialties including pulmonology, respiratory therapy, otolaryngology and audiology.

The University of Texas Health Science Center in Tyler 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 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 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, call UT Health East Texas Pulmonary Institute at North Campus Tyler at 903-877-7916.

Pulmonary function testing (PFT)

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.

Pulmonary rehabilitation

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.

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

To learn more or schedule an appointment for an pediatric patient with TB, call UT Health East Texas Pulmonary Institute at North Campus Tyler at 903-877-5271.

Zephyr endobronchial valve 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.

Our team includes certified and registered respiratory therapists trained to help people with lung problems on an emergency, inpatient or outpatient basis. They regularly work with people on ventilators, especially in emergency or ICU settings, and provide breathing and nebulizer treatments.

To learn more about our pulmonary care services or locations, please call us.