OUR PHYSICIANS

Each of our fellowship-trained physicians specializes in a unique aspect of care. 

Pulmonologists are experts in diseases of the lungs. They diagnose and treat chronic obstructive pulmonary disease, cancer, emphysema, pulmonary fibrosis, pneumonia, bronchitis, asthma, allergy, and other complex disorders of the lungs. Pulmonologists evaluate how well the lungs are functioning in many ways, including administering pulmonary function tests, chest x-rays, and cardiopulmonary stress tests.

Somnologists are sleep medicine physicians who identify sleep disorders, such as insomnia, sleep apnea, snoring, narcolepsy, restless leg syndrome, and sleepwalking. Sleep medicine is a specialty devoted to the diagnosis, testing, and treatment of sleep disturbances which would increase risk for heart disease, high blood pressure, stroke, and other conditions, if left untreated. A sleep study, or polysomnogram, is typically performed overnight in a specialized center where technicians attach painless electrodes to a patient to monitor his breathing, heart rate, brain activity, and cycles and stages of sleep.

Intensivists practice critical care medicine, enabling them to provide care in trauma centers and intensive care units by managing life support devices, breathing machines, chest tubes, catheters, monitors, and other equipment during life-threatening illnesses and injuries. 

 

CONDITIONS WE TREAT

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Shortness of breath
Shortness of breath on exertion, such as climbing several flights of stairs, can occur normally, but if it happens without strenuous activity, it may indicate other problems, especially in the heart or lungs.

Stress and anxiety, airway obstruction, pneumonia or other lung diseases, fluid buildup around the lungs or heart, coronary artery disease, heart dysfunction or infection, or lung damage may cause shortness of breath. Breathing becomes uncomfortable, and people feel as though they cannot get enough air into their lungs no matter how hard they try.

Diagnosing and treating shortness of breath is unique to each patient. Symptoms might worsen in certain positions, perhaps lying down, or during specific times, such as after several hours of sleep, or shortness of breath may present in combination with other medical issues.

Breathing exercises or meditation can help with the anxiety that often accompanies shortness of breath. A humidifier, supplemental oxygen, or incentive spirometer that improves lung function may be recommended. Light exercise can improve the flow of oxygen to the blood, and sleeping with the head elevated on extra pillows may make breathing easier at night.

Click here to read more about shortness of breath and its causes.

Chronic Cough
A cough is a reflexive response to an irritant. A persistent cough is not a disease, but may be a symptom of another condition. Chronic cough can indicate an irritated airway, lingering infection, dehydration, overuse of over-the-counter decongestant pills or nasal sprays, acid reflux, exposure to pollutants, or stress. Some people who take ACE inhibitors for high blood pressure experience a dry cough as a side effect of their medication. A chronic cough may also be caused by allergies, asthma, smoking, obstructive sleep apnea, lung illness or injury, or heart failure.

Uncontrolled, violent coughing may be a sign of pertussis, or whooping cough, a highly contagious respiratory disease that most commonly affects young children. Whooping cough has increased dramatically since the 1980s, and studies are underway to improve strategies to reduce the rates of infection. Vaccination remains the most effective way to prevent whooping cough.

No lingering cough should be ignored; a pulmonologist can help get to the bottom of what’s causing that irritating, involuntary reflex.

The Harvard Health Publication That Nagging Cough explains how a cough begins, what might be causing it, and why certain over-the-counter medications might be ineffective.

Asthma
Asthma is a respiratory condition that inflames and narrows airways, causing wheezing, shortness of breath, a tight feeling in the chest, especially during cold weather or exercise, or coughing – especially at night.

Allergens, chemicals, seasonal changes, and smoking can irritate the lungs and cause airway inflammation. Reactions vary from person to person, and are typically managed with daily medication, but a severe, rapid worsening of symptoms called an asthma attack may require immediate intervention or medical help.

Shouting, crying, laughing, rapid breathing, or panic can cause bronchial tubes to constrict, which may cause or worsen an asthma attack. As the lungs continue to tighten, breathing becomes more difficult, speaking may be impossible, and low oxygen in the blood may cause skin or lips to turn blue or even lead to unconsciousness. Knowing when, where, and how to get treatment is a critical part of living with asthma.

About 26 million Americans have some form of asthma, leading to nearly 2 million visits to emergency departments each year. The American College of Allergy, Asthma & Immunology suggests working with an allergist, having an action plan, recognizing triggers and early warning signs of a potential asthma attack, and using a peak flow meter can reduce the number and severity of attacks.

Learn more about asthma from the American Lung Association. .

COPD, Chronic Bronchitis, Emphysema
Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis, emphysema, or other diseases of the lungs that get worse over time, with symptoms such as coughing, shortness of breath, wheezing, chest tightness, and fatigue.

Spirometry or other lung function tests, radiological imaging, such as X rays and chest CT scans, and arterial gas blood tests that measure oxygen in the blood can help doctors diagnose COPD. Avoiding cigarette smoke, air pollution, chemical fumes, and dust, which have all been linked to COPD, is critical to managing symptoms. Oxygen therapy, medications, surgical procedures such as lung volume reduction and lung transplants, or bullectomy (removing large air sacs pressing on healthy lungs in patients with emphysema) may provide pathways to relieve symptoms, but currently, there is no cure.

Seven to 10 million Americans are diagnosed with COPD each year, and Alabama has one of the highest rates of COPD in the nation: almost 10% of adults 18 years and older were living with the condition in 2011, according to the Centers for Disease Control and Prevention (CDC).

Complying with modern-day treatment regimens does make a difference. Men are living longer with COPD; the CDC noticed a significant decline in death rates for COPD in men from 1999 to 2010. Women with COPD have yet to demonstrate such a decline, though one hopes the 2020 survey shows similar positive findings.

Bronchitis is an inflammation of the airways known as the bronchial tubes, which carry air to and from the lungs. Acute bronchitis has a sudden onset, typically occurs following a respiratory infection, and resolves in about 2 weeks, though residual coughing may last a bit longer. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that occurs when these swollen, inflamed airways produce excessive mucus, leading to fatigue, coughing, aches, and difficulty breathing in and out, affecting patients for months or even years.

Cigarette smoking or long-term exposure to dust, fumes, or chemical irritants may cause the condition. Lifestyle changes, including stopping smoking or removing the source of irritation, and using a humidifier or steam shower will help loosen mucus and relieve wheezing. Inhaled medicines that open the airway (bronchodilators), steroids (inhaled or in pill form) to reduce inflammation, and oxygen therapy may improve breathing and comfort.

Washing hands regularly, receiving recommended vaccinations, and avoiding people with colds or flu will help reduce the risk of bacterial and viral infections, which can worsen the symptoms of chronic bronchitis. Pulmonary rehabilitation may improve symptoms and quality of life by combining medical therapy with breathing strategies, nutritional counseling, and energy-conserving techniques.

The American Lung Association explains chronic bronchitis on its website.

Emphysema is a progressive, long-term lung disease that occurs when lung tissue is damaged or destroyed by smoking, air pollution, airway reactivity, alpha-1 antitrypsin enzyme deficiency, heredity, or other underlying causes.

People with emphysema have shortness of breath due to extreme inflation of the lung’s air sacs, or alveoli. Emphysema and chronic bronchitis are known as Chronic Obstructive Lung Disease, or COPD, because the airflow is literally obstructed – delayed or stopped – when oxygen and carbon dioxide cannot move freely in and out of the damaged lungs. Air gets trapped in the lungs when patients inhale, making it difficult to breathe and also preventing normal blood flow and oxygen transport through the lungs.

Chest x-rays, lung function tests, blood tests, and genetic testing (in cases of suspected enzyme deficiency) help confirm a diagnosis of emphysema. Patients may be treated with bronchodilators (medicines that allow the air passages to open more fully), steroids that reduce inflammation, antibiotics to treat pneumonia or other infections, and oxygen. Pulmonary rehabilitation may improve quality of life and make breathing and exercise more comfortable. Some patients may benefit from surgical intervention.

According to the American Lung Association, more than 3 million Americans have been diagnosed with emphysema.

Read more about emphysema and COPD from the American Lung Association.

Bronchiectasis
Bronchiectasis occurs when an infection or other condition damages the airways, causing them to become scarred and unable to clear mucus, the slimy substance that helps remove inhaled dust and other particles. When the mucus accumulates, bacteria may grow, leading to repeated lung infections and preventing air from moving properly in and out of the lungs. It can occur at any age, but begins most often in children as a result of cystic fibrosis, primary ciliary dyskinesia, or from an infection such as tuberculosis, pneumonia, or the flu. Symptoms from such airway damage may not appear until later in life.

Bronchiectasis may lead to respiratory failure, heart failure, or lung collapse. Although there is no cure for bronchiectasis, early diagnosis and treatment, along with modern advances in managing diseases such as cystic fibrosis, help patients manage their symptoms and enjoy a good quality of life.

For access to more information about bronchiectasis, visit the American Lung Association’s website.

Lung Cancer
Cancer is a disease caused by an uncontrolled growth of abnormal cells in the body, typically beginning in one small group of cells, then spreading through the blood and lymphatic systems to other parts of the body. Primary lung cancer begins in one or both lungs, while secondary lung cancer starts elsewhere in the body but spreads to the lungs.

Non-small cell lung cancer accounts for the majority of lung cancers, including squamous cell carcinoma, which forms in the lining of the bronchial tubes; adenocarcinoma, which forms in mucus-producing glands; bronchioalveolar carcinoma, which forms near air sacs; and large-cell undifferentiated carcinoma that forms near the surface. Small cell lung cancer begins when small cells quickly divide and form large tumors. Lung carcinoid tumors are very rare, grow slowly, and usually stay confined to one area.

Nearly 400,000 people in the United States are living with lung cancer, according to the National Cancer Institute, which notes 82% of these people are age 60 years or older.

People who smoke cigarettes and those who have been exposed to secondhand smoke, radon, asbestos, and other chemicals, as well as those with a family history of the disease, are at increased risk for developing cancer that begins in the lungs.

In early stages, lung cancer may not produce specific worrisome symptoms. Wheezing, hoarseness, shortness of breath, and chest pain can indicate a wide variety of problems in the lungs. As the disease advances, people may develop a new persistent or chronic cough, cough up blood, feel pain in their bones, lose weight without trying, or develop other signs that indicate cancer may be present. Some experts suggest people at increased risk for lung cancer have annual CT scans or other imaging tests to detect cancer early, when treatment options are most effective.

Each physician at Pulmonary Associates specializes in diagnosing disorders of the lung, including cancer. Our access to the most modern diagnostic technology and imaging methods enables us to partner with surgeons, radiologists, oncologists, and internal medicine specialists to identify the best course of treatment every step of the way for each individual patient.

The American Cancer Society offers information about prevention and early detection of lung cancer.

Pneumonia and Valley Fever
Pneumonia is a serious infection of one or both lungs, typically caused by bacteria, viruses, fungi, or parasites. These microorganisms grow rapidly in lung tissue, filling infected parts of the lung with fluid and pus.

Symptoms include cough, sometimes with sputum or phlegm; fever; chest pain when inhaling; and shortness of breath. Abnormal chest sounds heard with a stethoscope and a chest x-ray may confirm the presence of pneumonia, but blood tests, urinalysis, or sputum cultures may be required to determine the specific cause of pneumonia and identify the most effective course of treatment. Antibiotics may treat bacterial and fungal pneumonia, but are not effective in combating viral pneumonia.

Nearly 1 million people in the United States are hospitalized with pneumonia each year, according to the Centers for Disease Control and Prevention (CDC). People with viral infections, lung disease, heart disease, swallowing problems, and those who have suffered a stroke or seizure have an increased risk for contracting pneumonia. Several vaccines can lower the risk of developing pneumonia, including the pneumococcal conjugate vaccine, and vaccines to prevent underlying causes, such as influenza, pertussis, and varicella.

Learn more about preventing, treating and managing pneumonia from the CDC.

Tuberculosis
Tuberculosis is a slow-growing infection, usually present in the lungs, caused by breathing in air contaminated by a microbe named Mycobacterium tuberculosis. It is an airborne illness, spread through tiny droplets when a person with tuberculosis coughs, sneezes, laughs, speaks, etc. For someone to develop active tuberculosis, the bacteria Mycobacterium tuberculosis must enter the body and cause an infection that the immune system cannot contain. Some people are infected with tuberculosis, but the microbe remain dormant for years and do not cause active disease. Although these latent patients do not spread tuberculosis to others, they can eventually develop tuberculosis signs and symptoms, so medical treatment is always advised.

Early symptoms of tuberculosis include weight loss, fever, night sweats, and loss of appetite – vague signs that may go unnoticed. More debilitating symptoms include cough, chest pain, and bloody sputum.

To identify people who have been exposed to Mycobacterium tuberculosis, providers inject a substance called tuberculin under the skin of the arm. If a red welt or obvious reaction forms, an infection has likely occurred. Many people heal from their initial exposure to tuberculosis, and a positive skin test or evidence of scarring on a chest x-ray may be the only clue a person has ever been exposed. However, aging, infection, poor nutrition, or conditions that compromise the immune system may coax tuberculosis into an active infection.

Tuberculosis can usually be cured with appropriate antibiotics, but treatment typically includes a course of several drugs taken for several months, so complying with doctors’ orders is critical to conquering the infection. Drug-resistant tuberculosis is on the rise, and requires special tuberculosis drugs taken over a long period of time, which may lead to unwelcome side effects.

About 11,000 people are diagnosed with tuberculosis in the United States, although more than half of them were born in other countries, where they were more likely to be exposed, according to the Centers for Disease Control and Prevention.

Read more about tuberculosis from its discovery in ancient history to the latest treatment approaches from the National Institute of Allergy and Infectious Diseases.

Pulmonary Hypertension
Pulmonary hypertension is a lung disorder that occurs when the arteries that carry blood from your heart to your lungs narrow, causing blood pressure to rise far above normal levels. Symptoms may develop so slowly that pulmonary hypertension can go undiagnosed for years. It may be hereditary or be caused by heart disease, liver disease, rheumatic disorders (such as lupus), a blood clot in a pulmonary artery, or lung conditions, such as emphysema, COPD, or pulmonary fibrosis. Obesity and sleep apnea may also lead to developing pulmonary hypertension.

According to the American Lung Association, there are an estimated 300 new cases of primary pulmonary hypertension each year. It is more common in women, non-Hispanic blacks, and in people ages 75 or older.

Common symptoms include shortness of breath, fatigue, dizziness, chest pain, a racing hearTuberculosiseat, or swelling in the ankles, abdomen, or legs. Normal pressure in pulmonary arteries in people at rest is 8-20 millimeters of mercury (mmHg). In people with pulmonary hypertension, the average pressure in the pulmonary arteries is 25 mmHg or higher.

To diagnose pulmonary hypertension, doctors may perform a complete medical history and physical exam that includes listening for abnormal heart sounds, examining the jugular vein in the neck for swelling, and looking for signs of fluid retention, poor oxygenation, or other conditions that could cause pulmonary hypertension. Blood tests, pulmonary function tests, pulmonary angiograms, exercise tolerance tests, ventilation perfusion scans, chest x-rays, chest CT scans, heart catheterization, and other tests may help identify the condition and the best approach to individual treatment.

Treatment options can include oxygen, blood thinners, diuretics, potassium, digoxin, or medications that dilate pulmonary arteries, lower pulmonary blood pressure, block the action of substances that cause narrowing of lung blood vessels, or relax pulmonary smooth muscle cells. Surgery may be warranted if a large clot is found in the pulmonary artery, or if a patient is a candidate for organ transplantation.

Read more about pulmonary hypertension from the American Lung Association.

Sarcoidosis
Sarcoidosis is the growth of small collections of inflammatory cells (called granulomas) in different body parts, especially the lungs, lymph nodes, eyes, and skin. No one is certain what causes sarcoidosis, but experts believe it occurs when the body’s immune system reacts to an unknown substance that is likely inhaled. It may occur in people with a genetic predisposition and/or may be triggered by specific germs or chemicals.

Sarcoidosis symptoms mimic many other conditions. Fatigue, fever, weight loss, or swollen lymph nodes may occur. When sarcoidosis affects the lungs, it typically causes a dry, persistent cough, shortness of breath, wheezing, and chest pain. Symptoms may appear suddenly and then just as quickly disappear, or they may gradually develop. As granulomas grow, they can compromise the health of an organ, including the lungs.

A physical exam may be combined with x-rays, a CT scan, a PET or MRI study, blood tests, a biopsy using a bronchoscope, or lung function tests to diagnose sarcoidosis. Regular chest x-rays may monitor the condition over time. Corticosteroids, anti-rejection medications or TNF-alpha inhibitors may also be recommended to reduce inflammation if organ systems are threatened.

Sarcoidosis is most common in people ages 20 to 40 years. Women, African-Americans, and those with a family history of the disease appear to be more likely than other populations to develop the disease.

In the majority of otherwise healthy people, sarcoidosis may heal on its own, but left untreated, pulmonary sarcoidosis can cause permanent damage to lung tissue, causing pain or difficulty breathing.

Learn more about sarcoidosis from the National Heart, Lung, and Blood Institute.

Sleep Apnea
The Greek word “apnea” means “without breath”. Sleep apnea occurs when breathing spontaneously stops and starts or becomes very shallow during sleep. These pauses may last from seconds to minutes, several times an hour, resulting in choking or snorting when normal breathing resumes. Sleep quality is poor and accompanying snoring can be extremely loud.

Obstructive sleep apnea occurs when throat muscles relax and the soft tissues in the rear of the throat collapse during sleep.

Central sleep apnea is less common in the average population, may be triggered by certain medications or conditions, and occurs when the brain fails to signal involuntary muscles that control breathing.

Mixed sleep apnea is a combination of the two.

Actual signs and symptoms of sleep apnea can only be directly observed during a sleep study performed by a certified sleep medicine team, although partners and spouses are often more than happy to describe the loud snoring and choking sounds that are hallmarks of the disorder. People often fail to realize sleep apnea is the underlying cause of their daily fatigue, excessive daytime sleepiness, or headache and dry mouth upon waking.

The National Institutes of Health and the National Sleep Foundation estimate about 18 million American adults struggle with sleep apnea. People who are overweight are at greater risk for obstructive sleep apnea, which occurs more often in men and in people older than age 40. Children with enlarged tonsils may be at risk for obstructive sleep apnea.

Left untreated, sleep apnea may lead to depression, diabetes, high blood pressure, stroke, heart attack, or heart failure. Lack of quality sleep has also been shown to increase the risk of work-related and driving accidents.

A comprehensive study performed overnight in a certified sleep medicine center can identify the best approach to treating sleep apnea. A sleep medicine specialist can evaluate the study results and recommend effective treatment. Lifestyle changes, weight loss, nasal decongestants, positional therapy, mouthpieces, and positive airway pressure devices (which prevent the airway from collapsing during sleep and have become smaller and more comfortable in recent years) are just some of the options that relieve symptoms of sleep apnea and reduce its associated health risks.