ANEMIA – lower than normal number of red blood cells in the blood that can cause shortness of breath.  Anemia, or low blood count, is usually determined by the level of hemoglobin in the blood and is assessed by a simple blood test. Hemoglobin is the red pigment in red blood cells that transports oxygen and decreases in the amount of hemoglobin reduces oxygen transport. There are many causes and many types of anemia.

ARTERIAL BLOOD GAS – also known as an ABG, this is a lab test that gives information about how well oxygen and carbon dioxide are being exchanged in the lungs. Oxygen is taken from the air that is inhaled and goes through the lungs to the small blood vessels around air sacs of the lungs. The oxygen then goes to the heart and throughout the body. Carbon dioxide from the body is removed by the blood as it circulates through lungs and into the tiny blood vessels that surround the air sacs. The carbon dioxide crosses into the small air sacs where it is exhaled. ABG blood must be taken from an artery which is more difficult than drawing venous blood because arteries are deeper under the skin than veins. It can be uncomfortable. The information from this type of lab test is very important in some cases.

ASBESTOSIS – scarring of the lungs, or fibrosis, can be caused by inhaling asbestos fibers. The fibers become embedded in the airways, which causes the scarring. Inhaling asbestos can also cause the pleura, or outer lining of the lungs to thicken. Smokers who have asbestosis have a greater chance of having lung cancer than those who do not smoke. A specific kind of lung cancer, mesothelioma, is associated with smoking and inhalation of asbestos. Tumors form in the pleura or the lining of the abdomen in this type of lung cancer. There is no cure for asbestosis, but supplemental oxygen may improve shortness of breath. Lung transplantation may be an option for some people.

ASTHMA - inflammation of the airways that causes airflow into and out of the lungs to be reduced or obstructed. Asthma is a very common disorder that afflicts both children and adults. The muscles along the airways become tight and the lining of the air passages swells. Reduced airflow produces the wheezing sound that is characteristic of asthma. It can also produce shortness of breath and cough. Asthma can be a life-threatening condition and should be adequately controlled with excellent current therapies.

BRONCHIECTASIS - affects the large airways of the lungs with abnormal destruction and widening of the airways. It can be caused by recurrent respiratory infections and inflammation of the airways, inhaling a foreign object, cystic fibrosis or abnormality of the protective defenses in the airway; however some people are born with it. Frequent respiratory infections can occur and treatment can include antibiotics and techniques to help loosen and cough up the sputum that collects in the enlarged airways. Cystic fibrosis is one example of a disease that frequently produces bronchiectasis. Other less common disorders include gammaglobulin deficiency, bronchopulmonary aspergillosis, mucociliary abnormalities.

BRONCHITIS - inflammation of the bronchi, the main air passages to the lungs, called the bronchi. Bronchitis usually occurs following a viral respiratory infection or with prolonged cigarette smoking. Symptoms can include coughing, shortness of breath, wheezing and fatigue. CHRONIC BRONCHITIS - inflammation of the main air passages in the lungs, called bronchi. The symptoms persist over time and often recur. Chronic bronchitis is diagnosed when there is excessive mucus in the lungs, the cough produces increased or large amounts of sputum for three months or more in at least two consecutive years and there is no other disease that is causing these symptoms.

BRONCHIOLITIS – infection of bronchioles, the small airways of the lung. Children under two years of age are most often affected and some children can become very ill. The disease usually begins with mild upper respiratory symptoms that worsen to include wheezing, cough, an increased rate of breathing and difficulty breathing.

BRONCHOSCOPY – a test that allows the pulmonologist to look at the vocal chords, into the trachea, or windpipe and the lungs. Samples of cells and tissue of the lungs can be taken and used for further laboratory testing. A bronchoscopy may be used to diagnose several lung diseases, cancer, infection or blockage by tumor or foreign objects. This can be done as an outpatient procedure. An anesthetic is sprayed into the nose and mouth and a bronchoscope, a tube with specialized features such as camera and ability to take samples, is passed down the throat, trachea and into the lungs. Sedative medication can also be given. People who have had a bronchoscopy generally do not complain of pain with the procedure, but may have a mild sore throat, hoarseness or cough up small amounts of blood for a few days.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) – very common and serious chronic lung disorders that result in blocked air flow in the lungs. The two main COPD disorders are emphysema and chronic bronchitis. Emphysema occurs when the walls between the lungs’ air sacs become weakened and collapse. Damage from COPD is usually permanent and irreversible. Most patients with COPD are heavy smokers and smoking cessation is the most important therapy.

CIGARETTE SMOKING - inhalation of many hazardous substances or toxins, such as nicotine, carbon monoxide, and cyanide that damages the lungs. Smoking is associated with COPD, lung cancer, heart disease, strokes, lip/throat/stomach/bladder cancer, etc. Risk for chronic obstructive pulmonary disorder is also increased in people who have been exposed to second hand smoke over a period of time or have frequent respiratory infections.

COUGH – is a symptom of an underlying disease or other medical problem that most people assume are due to lung problems. There are several different causes of cough not related to the lungs. Gastroesophogeal reflux, allergies, post nasal drip and certain medications are common causes of cough. Cough can also be caused by an irritant in the airway, such as mucus or a foreign object. Cough can be dry, as in asthma, or can produce phlegm or mucus as seen in emphysema and chronic bronchitis. Both Emphysema and chronic bronchitis are chronic obstructive pulmonary diseases that produce increased amounts of sputum. Cough helps clear this from the lungs.

CT - computed tomography scan - is a type of x-ray that when used to image the chest gives much more detail of lungs, heart, blood vessels and bone that the standard chest x-ray. Tumors, blood clots, obstruction, thickened tissue and other abnormalities may be visible on the images made by the CT scan. The test can last from 20 - 90 minutes. Dye may be injected into the person for certain types of images.

DYSPNEA – Shortness of breath, difficult or labored breathing that is out of proportion to level of physical activity. It is a symptom of many diseases and disorders. This feeling results from a combination of signals from nerve endings in the lungs, rib cage, chest muscles, or diaphragm that are relayed to the brain. In some cases, the patient's sensation of breathlessness is intensified by anxiety about its cause. Some patients describe dyspnea as unpleasant shortness of breath, a feeling of increased effort or fatigue in moving the chest muscles to breathe, the feeling of being smothered, or a sense of cramping or tightness of the chest wall.

EMPHYSEMA - caused by damage to the air sacs (alveoli) in the lungs, most often from inhalation of the toxins such as nicotine, carbon monoxide and cyanide. There is progressive destruction of the alveoli and the surrounding tissue that supports the alveoli. Large air cysts develop as the disease progresses and air becomes trapped in the lungs because supportive tissue is gone. This decreases oxygenation and can result in the need to use supplemental oxygen. Emphysema is COPD, and is mostly due to excessive cigarette smoking, and is largely not reversible. Most important therapies are smoking cessation, home oxygen therapy if required, influenza vaccination, regular exercise, and some forms of inhalers medications.

HEART DISEASE – disorders of the heart can result in decreased blood supply to the heart muscle and result in shortness of breath. These include coronary artery disease, valvular disorders, heart failure. Heart disease can present with chest pain, shortness of breath, swelling, cough, wheeze or dizziness and is an important cause of death.

HYPERSENSITIVITY PNEUMONITIS - inflammation of the lungs that occurs after exposure to certain substances, usually organic dust from plants, molds or animal dander and is often related to a working environment or hobbies, such as owning birds, farming, etc. It may be referred to by different names depending on the cause of the inflammation, such as bird breeder’s lung, farmer’s lung or extrinsic allergic alveolitis. Avoiding the allergen is vital in the treatment of this disease. PLEURISY is inflammation of the lining of the lungs, called pleura. This causes pleuritic chest pain. This inflammation can develop with pneumonia, tuberculosis or other disease that causes inflammation of the lungs. Pain of the chest wall is often felt at the site of the pleural inflammation, and may be felt in the shoulder. Coughing, deep breathing and movement of the chest can increase the pain. his type of chest pain is different from the pain seen with heart attacks or cardiac disease.

INFLUENZA or “the flu” - a common viral infection usually caused by one of three strains, Influenza A, B or C. Influenza A and B leads to 20,000 deaths and hospitalizations of 100,000 people each year. This virus is transmitted from one person to another when an infected person sneezes or coughs and releases contagious droplets. Some individuals have a higher risk of complications of this disease and should receive the influenza vaccine to help prevent certain types of influenza. These include:

• 50 years old or older
• Diabetes
• Lung disease, such as asthma, COPD, bronchiectasis
• Heart disease or condition
• Kidney disease
• Health Care workers
• Those with weakened immune system, such as transplant recipients and people with HIV

INFLUENZA VACCINE - an injection in the arm to help prevent influenza, or "flu". The vaccine contains killed virus. The virus is initially grown in eggs so anyone allergic to eggs should tell their physician. Side effects can include mild muscle soreness, redness or swelling where the injection was given, low grade fever and mild body aches. Serious allergic reactions are rare. Serious reactions should be reported to the physician or office where the vaccine was given so they can report it to the appropriate agency. Difficulty breathing, wheezing, hives, fast heartbeat, dizziness or weakness that occurs within minutes to a few hours after the injection can become life-threatening. It is estimated that one person out of one million people who have had the influenza vaccine may develop Guillain-Barre syndrome of nerve damage, muscle weakness and fever.

LUNG CANCER – is abnormal cell growth that destroys normal lung tissue. A cluster of these cells is called a tumor which can continue to grow and interfere with normal lung function. Cigarette, pipe and cigar smoking is responsible for 90% of lung cancers. Radiation exposure, air pollution and exposure to certain industrial substances are linked to increased chance of lung cancer. Common symptoms of cancer of the lungs are cough, shortness of breath, chest pain and coughing up blood. These symptoms can also be due to other causes, not lung cancer. Testing to determine if a person has lung cancer may include chest x-ray, CT of the chest, bronchoscopy or open lung biopsy.

Treatment is determined by the type of cancer and how far the cancer has progressed. There are several types of lung cancer; small cell and non-small cell are the most common types. Certain specialists, pulmonologists, oncologists, thoracic surgeons and pathologists are important in the treatment of lung cancer and work together to design the best course of treatment for each individual.

NEUROMUSCULAR DISORDERS – can cause shortness of breath as the muscles that are necessary for breathing deteriorate and become weaker. Muscular dystrophy, Lou Gehrig’s disease and myasthenia gravis are examples of neuromuscular disorders.

PLEURAL EFFUSION (PE) - an accumulation of fluid between the pleura, the layered membranes lining the outer surface of the lungs and the chest cavity. Small amounts of pleural fluid lubricate the pleura for optimum movement and efficiency of the lungs in the work of breathing. Pleural effusion, where there is a larger than normal amount of pleural fluid, can make breathing more difficult, can cause cough and shortness of breath along with rapid breathing. Pleural effusion is usually caused by disruption of the normal pressure in the lung and usually represents an underlying disease process. Several disease states can alter the normal factors that keep fluid from accumulating, including congestive heart failure, inflammation of the pleura, cancer, tuberculosis, pneumonia, drug reactions, sarcoidosis, asbestosis and collagen-vascular diseases.

The cause of pleural effusion can usually be determined by removing a sample of the fluid by thoracentesis. Thoracentesis is a procedure, often performed in the physician’s office, in which a needle is inserted between the ribs into the chest cavity to obtain the pleural fluid. A local anesthetic is used. Several lab studies are routinely performed on the fluid to determine that cause or the underlying disease process.

PNEUMONIA - an infection of the lungs caused by a viral, bacterial or fungal infection. Pneumonia is a very common, often serious illness that affects about 3-4 million people each year in the United States alone. Patients present with cough, sputum, chest pain, fever, shortness of breath and there is usually an abnormality on a simple chest x-ray. Pneumonia is an important cause of death.

PPD - tuberculin purified protein derivative is a test to determine if a person has been exposed to tuberculosis.  This may be referred to as a TB skin test.  The PPD is injected just under the upper layers of the skin on the forearm.  If someone has been exposed to tuberculosis or has active tuberculosis the tested area will react and become hard and raised wth 48 - 72 hours.  If the test is positive, a chest x-ray is usually done to determine if there is active disease.  Medications must be taken daily for a period of time if there is active disease, or until it can be proven there is no tuberculosis infection.

PULMONARY EMBOLUS - blockage of a blood vessel in the lungs by blood clot, fat, air or a group of tumor cells. Blood clots that form in the veins in the leg (deep vein thrombosis, DVT) or pelvis and move to the lungs are most often the cause of pulmonary emboli. PE is preventable and when it occurs is treated by blood thinners.

Factors that increase the chance of having a pulmonary embolus include: prolonged inactivity such as bed rest; sitting for long periods of time on trips; oral contraceptive use; childbirth; serious burns; stroke; heart surgery; massive trauma; fractures of the femur or hips; and certain clotting disorders. 

PULMONARY FIBROSIS - thickening and scarring of the lungs. This can occur after exposure to asbestos, silicates and other materials or most often without any known exposures or causes. This is a serious disorder that occurs in older individuals and presents with cough and short of breath with exertion. The process is typically progressive over 1-2 years, patients have “crackling” noises in the chest, and have typical abnormalities on chest x-rays and CT scans.  Sometimes lung biopsies are performed and treatments are attempted with “immunosuppression” using prednisone and other medications. Most often these therapies are not particularly effective and the disease progresses and patients require home oxygen therapy.  There is a lot of research ongoing in this disease.

PULMONARY FUNCTION TESTING (PFT) - types of testing that measure a specific function of the lungs or documents specific volume of air in the lungs. The tests provide information about a diagnosis and can also be used to monitor effectiveness of medications.  PFTs are widely used by physicians to help measure lung function to diagnose lung disease. Several different types of tests including simple spirometry, lung volume measurement, diffusion capacity, arterial blood gases, and exercise studies can all be described by the term PFTs. These studies can be performed in the office or in a hospital setting. The active participation and cooperation of the patient is very important in getting useful information. 

PULMONARY HYPERTENSION - narrowing of the pulmonary arterioles within the lung. The narrowing of the arteries creates resistance and increases the work load of the heart. Over time the heart becomes enlarged from pumping blood against the resistance. Symptoms include shortness of breath, weakness, fatigue and chest pain. The goal is to treat the cause of the pulmonary hypertension and control the symptoms.  Pulmonary hypertension can occur with several different medical conditions (i.e. heart disease); disease of other parts of the body, or may occur in isolation (i.e. primary). There are several new medications that are helping patients with pulmonary hypertension.

PULMONARY REHABILITATION – individuals with lung disease may benefit from rehabilitation therapy to help improve lung function, exercise tolerance, help decrease how often a person gets sick and improve quality of life and life span. A person who participates in pulmonary rehabilitation will receive education about his or her lung disease, therapy and monitoring to ensure safety.

SARCOIDOSIS - a disease of unknown cause that most often affects the lungs. The disease is characterized by inflammation and formation of clusters of certain types of cells call granulomas, which represent the hallmark of the disease. The types of cells include macrophages, multinucleated giant cells and lymphocytes. These can occur in many organs but most commonly lymph nodes, lungs, skin, eyes, liver or other tissues in the body. The cause of sarcoidosis is unknown and its effect varies with each individual. For example, some individuals with sarcoidosis may have lung involvement only, others may have liver or some other tissue involvement. The disease maybe very mild sometimes (i.e. patients do not even know they have it) whereas other situations the disease can produce symptoms (due to the part of the body that is affected) and produce organ failure and occasionally death.

Sarcoidosis is more common among African Americans and Northern European Caucasians. There are more women than men of African heritage affected by this disease. There is active research into sarcoidosis in the Pulmonary and Critical Care Medicine Division at Brody School of Medicine at ECU. Environment, genetic predisposition, and immune response to infections are some possible causes of this disease. There are newer therapies beyond corticosteroids that are being investigated as possible therapy.

For more information about sarcoidosis and its treatments, click here.

SLEEP APNEA – Apnea is a lack of breathing and sleep apnea is the disorder of interrupted breathing while sleeping. The time without breathing in someone with sleep apnea may last 10 seconds to over one minute and happen many times in one hour and throughout the night. This is a serious medical problem, not only because a person with sleep apnea is at risk of falling asleep while driving or operating equipment and harming self and others, but also because it makes the heart and blood vessels work harder. This leads to hypertension, pulmonary hypertension and heart failure. Obstructive sleep apnea is the most common type and occurs when there is partial blockage of the upper airway. Someone with obstructive sleep apnea may recall waking up abruptly during the night gasping as they take a breath after an episode of apnea. However, often the person does not fully wake up or remember waking up. Another type of sleep apnea that is much less common is central sleep apnea that occurs because the brain does not signal the body to breath like it normally does.

A polysomnogram, or sleep study, can be done to determine if a person has sleep apnea and what kind of sleep apnea. If someone does have sleep apnea, the second part of the polysomnogram is to determine how to best treat it. CPAP (continuous positive air pressure or BiPAP (bi-level positive air pressure) are two methods that correct sleep apnea. The type of device and setting of air flow is determined during the second phase of the study. Sometimes surgery is recommended to remove tissue from the soft palate and area surrounding the palate. If someone with sleep apnea is overweight, weight loss can often eliminate sleep apnea.

SMOKING CESSATION – Quitting smoking can be a very difficult challenge. Smoking is the greatest cause of lung cancer, as well as chronic obstructive pulmonary diseases – emphysema and chronic bronchitis. Over time, lung damage can be so severe that a person must use oxygen. Each person responds differently to different methods of quitting smoking and often a combination of methods is most successful. It is important to discuss the various methods with your physician.

To learn more about quitting smoking, click here.

SPIROMETRY – a type of PFT, is a painless study wherein the patient initially takes a deep breath and then rapidly blows out the air in the chest into a measuring device known as a spirometer. The device measures exhaled volume and airflow from the lungs that is frequently used to evaluate lung function. This is one part of a PFT used in people with obstructive lung diseases such as asthma, COPD, or cystic fibrosis.

THORACENTESIS - a procedure to remove fluid from the pleural space, the area between the chest wall and lungs. It can be done to help diagnose the cause of a pleural effusion, or abnormal collection of fluid. If the collection of fluid is very large, thoracentesis can also be used to remove the fluid, which can improve breathing by relieving pressure caused by the fluid pressing against the lung. This procedure can be done in the pulmonologist's office. A chest x-ray is taken before the procedure so the physician can determine where the fluid is. The area where the needle will be inserted is cleaned and numbing medication is used before inserting the needle. A person having this procedure usually sits upright, leaning forward slightly, resting on some type of support such as an examination table. Afterward, the person can rest quietly for about one hour. Occasionally the needle may cause a small puncture in the lung and there may be some collapse of part of the lung. If this happens, breathing may become difficult and chest pain may develop. Chest x-ray can be done to determine how much the lung has been affected. Minimal lung collapse will most often get better in time with no intervention.

For more information about this and other procedures, please click here.