Diseases & Disorders Related to the Respiratory System

Sleep Apnea is the cessation of breathing during sleep which results from the relaxation of the muscles of the upper airway. Snoring and snorting are the primary symptoms (or markers) of sleep disordered breathing. The patient wakes up repetitively, feeling as tired in the morning as they did when they went to bed. He or she may never realize that they have awakened. Often it is a partner that informs the patient of their condition. Most patients experience a myriad of issues during the day which when viewed together can help to lead to proper testing. They feel fatigued and have difficulty concentrating while awake; many have morning headaches, GERD (gastro-esophageal reflux disease,) daytime fatigue, personality & mood changes (including depression and anxiety,) cognitive deficits, memory and intellectual impairment, decreased vigilance, hypertension and sexual dysfunction (including impotence and decreased libido.)

Diagnosis is aided by patient history, a simple questionnaire, and a physical exam. Testing to document obstructive sleep apnea is usually performed at the patient’s home with the use of a “home sleep study.”

Treatment is most commonly with the use of CPAP (continuous positive airway pressure) machine and mask which helps to maintain airway patency. In mild cases, dental devices may be used. In many cases weight loss is advised. Most patients notice significant improvement in their daytime functioning with treatment of their disease.

Asbestos is a mineral that was used for years to strengthen and fireproof various products throughout the construction industry affecting plumbers, pipefitters, steam fitters, electricians and others. The U.S. military mandated its use in every branch of service because of its effectiveness. The National Institute for Occupational Safety and Health (NIOSH) estimates that more than 75 different types of jobs in the U.S. expose workers to asbestos. Unfortunately, asbestos is highly toxic. Inhalation of the fibers can cause disease. More than 80 percent of those stricken with asbestos-related conditions are men.

Asbestosis, Mesothelioma, lung cancer and asbestos related pleural disease are all caused by inhalation of asbestos fibers.

Asbestosis is disease of the lung caused by inhaling asbestos. Prolonged exposure causes pulmonary fibrosis (scarring and destruction of the lungs.) Patients describe severe shortness of breath, labored and painful breathing, coughing and fatigue. The onset of disease can be many years after exposure and when it occurs, it is irreversible.

Treatments available include medications, oxygen therapy, humidifiers and chest physical therapy.

Mesothelioma is an aggressive and deadly form of cancer. It is believed to be primarily from exposure to asbestos. Most people with years of asbestos exposure never develop mesothelioma, yet, others with short periods of exposure do get the disease. As mesothelioma spreads in the chest, people experience difficulty breathing, chest pain, difficulty swallowing, and pain caused by pressure on the nerves and spinal cord. They also develop an accumulation of fluid in the chest (pleural effusion,) which can compress the lung nearby and make breathing more difficult.

Doctors can find evidence of prior exposure to asbestos by examining chest X-rays and CT scans.

Mesothelioma treatments are available, but for many people a cure is not possible. Surgery is an option if found early enough, but often this disease is found in the late stages. Procedures are available to relieve pressure on the lungs. Other supportive and comfort measures are also available.

Lung cancer is the uncontrolled growth of abnormal cells in the lungs. These abnormal cells do not carry out the functions of normal lung cells. Approximately 85- 90% of lung cancer cases occur in people who have smoked. About 10-15% have never smoked but have had some significant exposure to either second hand smoke or to other toxins or radiation. There are most likely genetic factors which predispose a person to lung cancer. Lung cancer can spread to multiple organs.

Symptoms of lung cancer include shortness of breath, coughing up phlegm or mucus, especially if it persists or becomes intense, coughing up blood, recurrent lung problems, such as bronchitis or pneumonias, changes in the voice or being hoarse, night sweats, malaise, weakness, loss of appetite, and weight loss. If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands.

When a screening procedure (CT, MRI or PET scan) results in suspicion of lung cancer a biopsy must be done. One method of obtaining a biopsy is by bronchoscopy. While the patient is sedated, the doctor inserts a small tube through the mouth or nose and into the lungs. The tube has a light, a small camera and a surgical instrument on the end. This allows the doctor to see inside the lung and to remove a small tissue sample. Surgery, radiation, chemotherapy, targeted treatments and immunotherapy — alone or in combination—are used to treat lung cancer.

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This restricts air flow to your lungs. You may feel short of breath and you may cough and/or wheeze. Asthma is generally intermittent, reversible and manageable with the proper treatment. For most people, while chronic, asthma is mild and barely interferes with their lives; some people, however, can experience severe and even lifethreatening symptoms.

Asthma episodes or “attacks” are triggered by a variety of things. Some of them include acid indigestion, sinus infection, upper respiratory infection, sudden exposure to cold air, exercise, and even allergies –for example to animals, mites, or weeds, to name a few. Symptoms can be worse at night. In between Asthma “attacks,” you may experience no symptoms at all.

Pulmonary function tests (PFTs,) and methacholine challenge testing can help to confirm the diagnosis.

Doctors can prescribe medication and lifestyle changes to treat asthma. With effective management, you can lead a relatively normal life.

Chronic bronchitis is a condition characterized by coughing that has lasted over 3 months. More commonly people suffer from acute bronchitis. It lasts only a week or two before resolving completely. Coughing is due to inflamed and narrowed bronchial tubes which prevent a person’s ability to breathe out completely. The inflammation also causes an increased production of mucus. People who suffer from chronic bronchitis cough frequently in order to clear this mucus from their airway. Any upper respiratory congestion, viral or bacterial infection of the bronchial tubes can worsen the symptoms.

Exposure to smoke, high levels of pollution, cold air or perfumes aggravates chronic bronchitis as well.

If necessary after physical examination, a chest x-ray and pulmonary function testing will be done to confirm the diagnosis.

Doctors treat this condition with medications making it easier to breathe and decreasing the effect of mucus.

Emphysema is a condition that gradually causes shortness of breath. Patients are fatigued and short of breath, but usually do not cough or expectorate mucus unless they also have chronic bronchitis.

Emphysema destroys the tiny air sacks of the lungs (alveoli.) Because of this, when you exhale, the damaged alveoli don’t work properly and air becomes trapped, leaving no room for your next inhalation. Normally, when you exhale, your lungs deflate going back to their normal size. In people with emphysema a small amount of air remains in the lungs after each breath. The lungs hyperinflate, that is, they gradually increase in size as they accumulate the air retained after each breath.

The main cause of emphysema is long-term exposure to airborne irritants, including tobacco and marijuana smoke, air pollution, chemical fumes and dust. People who have emphysema are also more likely to develop a collapsed lung, and heart problems.

Your doctor can treat the condition with medication, oxygen, nutrition therapy and pulmonary rehabilitation. Surgery is also an option depending upon the severity of your emphysema.

COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Patients with chronic obstructive pulmonary disease (COPD) experience the symptoms of either or BOTH emphysema and chronic bronchitis. In other words, they have symptoms of mucus production and a cough characteristic of chronic bronchitis in addition to the shortness of breath and fatigue related with emphysema.

In order to confirm the presence of COPD your doctor will obtain a history from you of any previous illnesses, and of symptoms you have had on a long-term. Your physician will also ask you about smoking cigarettes and any possible toxic exposures in your work place. A chest x-ray in severe cases of COPD will show flattening of the diaphragm (the large muscle that contracts to expand your lungs drawing air in) and unusually large lungs and air sacks at the top of your lungs (bullae). In milder cases of COPD the chest x-ray may be completely normal.

The most important diagnostic tools your doctor will use to evaluate you for COPD is a series of Pulmonary function tests. These will measure the amount of air a person can exhale from his or her lungs in a single breath, the ability of the lungs to extract oxygen from the surrounding air and will measure the size of the lungs. The total lung size and residual air trapped inside the lungs is greater in the patient with COPD. Patients with emphysema will also not extract oxygen from the air normally due to the destruction of the tiny air sacks in the lungs (the alveoli).

Treatment is designed to ease symptoms. It may include medications, oxygen therapy, and even surgery if your case is severe and you are a candidate.

Deep vein thrombosis (DVT) is a formation of a blood clot in the veins of the leg. It results from a decrease in the blood flow in the legs. Causes range from prolonged inactivity, such as that from bed rest after surgery or due to protracted illness, to pregnancy, cancer, birth control pills, and to smoking (smoking adversely affects blood clotting and circulation) and obesity (being overweight increases the pressure in the veins in your pelvis and legs.)

Patients often experience swelling in one leg, and they may have pain and difficulty walking as well. Permanent damage may result if not treated. More concerning is the potential for development of an embolism (a clot that moves through the bloodstream and blocks an artery in the lung.) If an embolism lodges in the lung, a person can experience severe shortness of breath, chest pain and even death.

Due to the risk of pulmonary embolism, patients with a deep vein thrombosis extending above the knee require therapy with anticoagulants. This therapy may be prescribed for months to prevent recurrence. During this therapy, a person is susceptible to bleeding. So, these patients should avoid activities with a high risk of injury and must attend scheduled appointments with their doctor for close monitoring.

Pulmonary emboli are blood clots that suddenly lodge in an artery in the lungs and prevent blood from flowing normally. Symptoms of a PE may include rapid breathing (faster than 20 breaths per minute) or shortness of breath, chest pain (particularly upon breathing in,) and coughing up blood. You may have a rapid heart rate (faster than 100 beats per minute), and sometimes a mild fever. You may also have symptoms of a blood clot in the leg such as a red, warm, swollen, and painful leg. Severe cases can lead to passing out, abnormally low blood pressure, and sudden death. Emboli usually begin as clots in the veins of the legs (DVT). Some conditions that might increase the likelihood of emboli are cancer, inherited problems with blood clotting, and cigarette smoking. Pregnancy, the use of birth control pills or prolonged immobilization associated with surgeries or long trips also increase a person’s risk of developing a DVT and pulmonary emboli.

Doctors can perform a CT pulmonary angiography, a lung ventilation/perfusion scan, or ultrasound of the legs to confirm the diagnosis.

Pulmonary emboli are usually treated with blood thinners called anti-coagulants. During this therapy, patients should ensure that they keep appointments with their doctors in order to be monitored properly. Blood thinners also increase the risk of bleeding. Consequently, patients with prior histories of internal bleeding or an intracranial hemorrhage may not be candidates. In these cases, the insertion of a titanium filter in the large vein in the abdomen (the vena cava) catches clots that have dislodged from the legs preventing travel to the lungs.

Pneumonia is an infection of the lungs. General symptoms include chest pain, fever, sweating and chills, cough, and shortness of breath. Adults age 65 and older may experience confusion or changes in mental status. Pneumonias come from bacteria (bacterial pneumonia) and other microorganisms, including viruses and fungi. Some pneumonias (especially viral pneumonias) may be spread from person to person through respiratory droplets. A small percentage also comes from birds living in the house (psitacosis), sheep (Q fever), or wild animals (tularemia). How long pneumonia lasts depends upon the organism that caused it & other factors regarding your overall health.

For most people pneumonia can be treated with medications at home. For others, when symptoms are severe or other health problems cause complications, treatment may require admission to a hospital.

Sarcoidosis is a disease that causes inflammation and scar formation in the lymph nodes at the center of the chest and in the lungs, eyes and skin. It can be difficult to diagnose because sarcoidosis produces few symptoms in its early stage. Often the signs and symptoms that are present mimic those of other conditions.

There is no cure for sarcoidosis, but most people do very well with little treatment. In fact, in approximately 40% of cases, sarcoidosis often goes away on its own. For some, though, it may last for years and lead to organ damage. In more severe cases of sarcoidosis, the inflammation and scarring causes shortness of breath, cough and fatigue, joint pain, change in mental status and can cause cardiac arrhythmias and seizures. Although the cause is not known for certain, it affects women more often than men.

Diagnosis requires biopsy in most cases. Biopsy via bronchoscopy is often done.

If symptoms do not resolve on their own, your doctor can manage them with medication. If severe damage to your lungs has occurred, you may be a candidate for transplant.

Tuberculosis (TB) is a bacterial infection that usually affects the lungs. TB is spread from one person to another through tiny droplets released into the air when an affected person coughs or sneezes and so TB remains a concern – especially in inner cities, in patients infected with the AIDS virus and in immigrants from third world countries.

The most common symptoms of TB are: a cough for three weeks or longer, weight loss, loss of appetite, high fever, night sweats, extreme tiredness or lack of energy. Often patients with tuberculosis lack symptoms and physicians frequently discover early tuberculosis on screening chest x-rays or skin tests designed to detect tuberculosis.

Tuberculosis is usually curable with medications.

Narcolepsy is an uncommon sleep disorder where patients usually present with daytime sleepiness. Patients with narcolepsy sometimes suffer from sleep paralysis and cataplexy. Sleep paralysis is a temporary inability to move or speak that occurs when you’re waking up or falling asleep. Cataplexy is the sudden onset of severe weakness following an emotional response such as laughing. Without warning the individual may abruptly and unexpectedly fall asleep. This can occur to people with the disorder right in the midst of performing normal everyday activities.

Individuals with narcolepsy will have an EEG pattern and eye movements that demonstrate a tendency to fall immediately into rapid eye movement (REM) phase of sleep. This distinguishes them from normal individuals who gradually progress from the early stages of sleep to REM sleep.

After diagnosis, physicians treat the disorder with medications that keep patients awake during the day and prevent the sudden, unexplained sleep attacks typical in narcolepsy.

Insomnia is the inability to fall asleep or to stay asleep at night. Patients are exhausted during the day because they have tossed and turned all night and have slept only for brief periods. This inability to sleep can be caused by medical conditions, unhealthy sleep habits, and specific substances or medications or psychiatric reasons. In some cases, the symptoms of a medical or psychological condition cause discomfort that can make it difficult for a person to sleep. Some examples are sinus allergies, gastric reflux, arthritis, asthma, chronic pain, or endocrine problems such as hyperthyroidism, and neurological conditions such as Parkinson’s disease. Depression can also cause insomnia – in fact, symptoms of depression (such as feelings of sadness or hopelessness, low energy, loss of interest or motivation) and insomnia can be related, one can make the other worse. Insomnia may also be a symptom of underlying sleep disorders such as restless legs syndrome or sleep apnea. Paradoxically, some of the medications taken for these conditions can also cause insomnia.

Diagnosis is by physical examination and patient history.

Doctors can treat insomnia effectively using behavioral therapy and medication.

Restless leg syndrome is a condition in which patients have an unpleasant and uncontrollable urge to move their legs prior to falling asleep. The urge to move the legs occurs or worsens in the evening & during periods of inactivity rather than during the day. The unpleasant sensation is often transiently relieved by moving your legs. Approximately 85% of patients with RLS have periodic limb movements of sleep (PLMS.) This constant movement disrupts the patient’s sleep and may result in repeated awakenings during the night. Understandably, this leads to sleepiness during the day.

All patients with symptoms of RLS should be tested for iron deficiency.

Medications are available to help alleviate the symptoms.

Sleepwalking, night terrors and bed-wetting are the most “well known” parasomnias. These are abnormal, unwanted behaviors that occur during sleep. Parasomnias may include abnormal movements, behaviors, emotions, perceptions or dreams. And even though the behaviors may appear purposeful to others, you remain asleep during the event and often have no memory that it occurred.

Doctors may use overnight sleep studies (polysomnography) to diagnose these disorders.

If an overnight sleep study demonstrates a parasomnia, doctors may prescribe medications and behavioral therapies to treat the problem.

Pulmonary and Sleep Services in Hunterdon County, NJ

Hunterdon Pulmonary and Sleep Associates provides a full range of Pulmonary and Sleep services for the diagnosis and treatment of lung disorders, respiratory diseases and sleep disorders.