Asthma
Symptoms of asthma include shortness of breath, wheezing and coughing that comes and goes, with normal breathing in between episodes. Triggers include cold weather, allergies, heartburn/GERD (gastroesophageal reflux disease), and strong odors (cigarettes, cleaning chemicals). Asthma can sometimes be diagnosed by symptom history alone, but may require a pulmonary function test (PFT) and possibly a methacholine inhalation challenge (MIC) test. There are many treatments available to help asthmatics live a normal, active life. www.nhlbi.nih.gov

Shortness of breath/dyspnea
Shortness of breath, or dyspnea, can have several causes. Among them include problems with the lungs (asthma, COPD), problems with the heart (heart failure, leaky valves), being overweight, and being out of shape. Our providers are well-versed in determining the cause of dyspnea and in developing a treatment plan.

Persistent/chronic cough
There are many causes of a persistent or chronic cough. The most common causes include lung problems (asthma, COPD), viruses, allergies, post-nasal drainage, and gastroesophageal reflux disease (GERD). While most causes are not life-threatening, our providers recognize the impact of chronic cough on the lives of their patients and loved ones. They will work hard to identify the cause of the symptoms in order to stop the cough cycle.

COPD (chronic obstructive pulmonary disease)/Emphysema/Chronic bronchitis
COPD (chronic obstructive pulmonary disease) is a general term used for a group of diseases including emphysema, chronic bronchitis and bronchiectasis. All of these diseases cause problems with expiration, or breathing out. Symptoms include shortness of breath, productive cough and wheezing. These symptoms tend to worsen over time. Triggers include increased humidity, increased temperature (summertime), and viruses. The main cause of COPD is cigarette smoking, which causes irreversible lung damage. Important tests for COPD patients include chest x-rays and pulmonary function tests (PFT’s). Medications can be used to keep the airways open and help prevent flare-ups. There are also several new therapies available by research protocols only. www.goldcopd.com

Pulmonary hypertension
Pulmonary hypertension is high blood pressure in the artery leading from the heart into the lungs. That causes problems circulating the unoxygenated blood into and through the lungs, which results in less oxygenated blood available for general circulation through the body. It is very different than high blood pressure that is measured by placing a cuff around the arm. Symptoms include shortness of breath and chest pain which is not helped by inhalers. Causes include blood clots in the lungs, untreated obstructive sleep apnea, connective tissue diseases (scleroderma, lupus), and heart problems (leaky or stiff valves, weak heart muscle). Some people have pulmonary hypertension without any known cause, which is called idiopathic. There are specific tests that are performed to help identify pulmonary hypertension, as well as specific medications used to treat the condition. www.phassociation.org

Interstitial lung disease/pulmonary fibrosis
Pulmonary fibrosis is essentially scarring in the lungs. It can be caused by inhaled environmental or occupational pollutants, certain medications, radiation to the chest, and connective tissue diseases such as scleroderma, lupus and rheumatoid arthritis. It causes problems with inspiration, or breathing in. Symptoms include shortness of breath, dry cough, chest discomfort, decreased appetite and weight loss. Medications can sometimes be used to help slow the disease progression. There are also clinical trials available for patients diagnosed with pulmonary fibrosis. www.pulmonaryfibrosis.org

Smoking cessation
Nicotine addiction can be tough to beat. There are several medications available to help, as well as several available through clinical trials. Our providers are well-versed in these medications as well as behavioral modification techniques to help those interested in quitting smoking. In addition, they will address any symptoms that could be related to illnesses caused by smoking. The more help a person uses to quit smoking, the higher their success rate. www.lungusa.org

Abnormal chest x-rays/CT scans
Hearing about an abnormality found on chest x-ray or CT scan can be scary. Masses, nodules, infiltrates, effusions, atelectasis, and adenopathy are all fancy words used to describe these abnormalities. Some are from infection, some are scarring, some are inflammatory, and some are cancerous. Our providers can perform procedures to make a positive diagnosis, as well as provide follow-ups or referrals as appropriate.

Nontuberculous mycobacterium
Mycobacteria are a group of bacteria that can cause lung infections. One in particular, mycobacterium tuberculosis, causes the familiar form of tuberculosis (TB). Other mycobacterial species (such as mycobacterioum avium and mycobacterium kansasii) can cause low-grade, chronic lung infections and failure to thrive, but are not considered contagious like TB. Our providers can perform the appropriate testing to identify and treat each specific bacteria. www.njc.org

Sarcoidosis
Patients with pulmonary sarcoidosis are often diagnosed based on an abnormal chest x-ray or CT scan. It causes enlarged lymph nodes (adenopathy) in the chest. It can also cause shortness of breath, wheezing and skin rashes. The disease course can range from no symptoms at all to death, with most people having symptoms for a period of time and the disease going away without further problems. Confirming the diagnosis usually requires biopsy of an affected lymph node. Treatment involves corticosteroids, like prednisone. Pulmonary function test and labs, including blood counts (CBC), electrolytes (like potassium and sodium), and ACE (angiotensin converting enzyme) levels can be followed to monitor effects of the disease. www.nhlbi.nih.gov

Snoring/obstructive sleep apnea syndrome (OSAS)
Most, if not all of us have experienced someone snoring. It can range from light, intermittent to loud and disruptive. Unfortunately for the snorer it can be a sign of a more serious disease, obstructive sleep apnea (OSA). Symptoms of OSA include snoring, stopping breathing or pauses during sleep (called apnea), daytime fatigue, morning headaches, depression, and problems with memory and concentration. Untreated, it can lead to accidents, high blood pressure, strokes, and heart attacks, and makes diabetes more difficult to control. It can stress relationships, as the bed partner’s sleep is disrupted as well. Evaluation for OSA includes a polysomnogram, which is an overnight sleep test. This will determine the presence and severity of any OSA. There are several treatment options available including nasal continuous positive airway pressure (CPAP), weight loss, an oral appliance, and radiofrequency somnoplasty. Your options are based on several things, including the severity of your illness, previous options tried and/or failed, and insurance requirements. Regular follow-ups are important to be sure your therapy is optimized. www.sleepapnea.org

Insomnia
Many people experience occasional problems falling asleep, staying asleep, or both. For some, the problem becomes so severe that it negatively affects their daily functioning. It is important to rule out other sleep problems, such as obstructive sleep apnea and restless legs syndrome/periodic limb movement disorder. It is also important to evaluate medications, lifestyle, and sleep habits, as they have a direct impact. There are many medications available that are safe, even for long-term use, as well as behavioral/relaxation techniques that can be used. www.sleepfoundation.org

Narcolepsy
Narcolepsy is often misunderstood. It involves excessive daytime sleepiness such that the need to sleep overrides daytime functioning needs. It also can involve poor quality sleep overall, with some people also experiencing cataplexy, or sudden loss of muscle tone often due to strong emotion (“sleep attack”). People with narcolepsy are often thought of as being lazy and having poor self-control. In reality, narcolepsy is a disorder of the wake-center of the brain. A deficiency of hypocretin has been found in the brain fluid of some patients, but the overall mechanism of narcolepsy is not fully understood. The diagnosis of narcolepsy is made with an overnight sleep test (polysomnogram) followed by a daytime “nap challenge” (multiple sleep latency test, or MSLT). Treatment for narcolepsy includes stimulant medications and lifestyle management. If properly treated, people with narcolepsy can live a normal life. www.narcolepsynetwork.org

Restless legs syndrome/periodic limb movement disorder
People with restless legs syndrome (RLS) have an uncomfortable and irresistible urge to move their legs, which happens during periods of inactivity, such as sitting or lying down. It tends to start in the evening and can last through the night. It is relieved by moving the legs. Periodic limb movement disorder (PLMD) has similar symptoms to RLS but happens only during the night. It is important to rule out anemia and other sleep problems such as obstructive sleep apnea (OSA), as these must be treated first. Many people have RLS/PLMD without any identifiable cause. The good news is that there are medications available to help, and it has no relationship with Parkinson’s disease (another motion disorder). www.rls.org

Other sleep disorders
Sleep eating, parasomnias, night terrors, shift work sleep disorder, delayed sleep phase syndrome, sleep walking and REM-behavior disorders are examples of sleep disorders that are less common. If you think you have a sleep disorder, please discuss it with your provider, as there is most likely a treatment available that can improve the situation. www.sleepfoundation.org

CPAP service/supplies
One of the most important influences on a patient’s success or failure with nasal continuous positive airway pressure (CPAP) is follow-up. Even if it seems “little” or that it is a recurrence of previous problem (no matter how many times), please speak up! The key to success is a positive, interactive relationship between patient and provider. A CPAP that is not used will not help, and sleep apnea can have serious consequences if not treated appropriately. Our providers, respiratory therapists, sleep technicians and nurses are knowledgeable, sympathetic, and professional. Our office staff is knowledgeable in a variety of insurance plans. Together, we are dedicated to doing what it takes to make our patients’ CPAP experience as efficient and enjoyable as possible. www.sleepapnea.org