Pulmonary Medicine

Cincinnati Magazine consistently ranks Tri-State Pulmonary Physicians among the top pulmonologists in the Greater Cincinnati area. We utilize cutting-edge medical technology that allows us to provide the highest standard of care. We deliver comprehensive care for all lung and breathing conditions/ diseases for patients in the hospital, outpatient rehabilitation and our many locations throughout the tristate area. Our services include:

– Clinical Areas of Expertise

+ Pulmonary Care

Our Pulmonologists—also known as Pulmonary Specialists or Lung Doctors—are all board certified in Pulmonary (Lung) Medicine. Pulmonologists deal with the causes, diagnosis, prevention and treatment of diseases affecting the lung. They provide pulmonary consultations for patients in outpatient clinics as well as for those in the hospital. Services include pulmonary consultations, treatment and follow-up and high-risk pre-operative evaluations. Our physicians help analyze and treat people that are short of breath or have low oxygen levels.

Our physician’s clinical area of expertise includes:
Acute Lung Injury
Acute Respiratory Distress Syndrome (ARDS)
Chronic Obstructive Pulmonary Disease (COPD)
Control of breathing
Interstitial Lung Disease
Lung Nodules
Lung Cancer
Occupational Lung Disease
Pulmonary Embolism
Pulmonary Hypertension
Pulmonary Vascular Disease
Sleep Apnea
Unexplained Shortness of breath
Diagnostic tests –
Pulmonologists use many different diagnostic tools to evaluate the structure and function of the lungs. Patients are frequently asked to have a chest x-ray, cat scan and basic breathing tests, called pulmonary function tests.

+ Asthma Care

Despite the availability of effective asthma treatments and evidence-based management guidelines focusing on asthma control, many patients have asthma that is difficult to effectively treat. Our comprehensive asthma treatment program is physician driven and patient managed. Patients are given the tools they need to effectively manage their asthma symptoms.

What is Asthma?
Asthma is a chronic lung disease that makes it difficult to move air in and out of the lungs. It affects people of all ages. Asthma can be serious and life threatening, requiring every day management of symptoms. There is no cure for asthma, but with the right care it can be managed. To learn more about more about asthma click here http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-is-asthma.html.

Treatment of Asthma
The physician/patient relationship is very important in successful asthma care. Our physicians work with the patient to create an individualized asthma treatment plan. Two types of medicines are used to treat asthma: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or “rescue,” medicines relieve asthma symptoms that may flare up. Your initial treatment will depend on the severity of your asthma. Follow up asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

Bronchial Thermoplasty
Unfortunately, there still remain situations when traditional management guidelines are not effective in controlling asthma exacerbations. When this happens we then look to other methods of treatment such as bronchial thermoplasty. Bronchial thermoplasty (BT) is a minimally invasive bronchoscopic procedure performed in three outpatient procedure visits, each treating a different area of the lungs and scheduled approximately three weeks apart. After all three procedures are performed; the bronchial thermoplasty treatment is complete. BT may be appropriate for patients 18 years and older whose asthma is not well-controlled with inhaled corticosteroids and long acting beta agonists.
The Alair® Bronchial Thermoplasty System (the Alair® System) delivers thermal energy to the airway wall in a precisely controlled manner in order to reduce excessive airway smooth muscle (ASM). Reducing airway smooth muscle decreases the ability of the airways to constrict, providing long-lasting asthma control and improving the quality of life for patients with severe asthma.

Risks may include:
•Increase and worsening of asthma-related respiratory symptoms in the period immediately following BT
•These events typically occur within a day of the procedure and resolve on the average within seven days with standard care
•There is a small possibility (3.4% per procedure) that the temporary worsening of asthma symptoms after a procedure may result in the patient being admitted to the hospital for management of asthma symptoms.

+ Lung Nodule Evaluation

Evaluation of Lung Nodules and Lung Cancer
It is not uncommon to discover lung nodules on a CT scan looking for other disorders. In general, the majority of lung nodules are benign. Tri-State Pulmonary Physicians provide quick evaluation of lung nodules and recommend future treatment or evaluation when needed. The earlier lung cancer is detected the greater the survival rate. Our physicians are participating in The Christ Hospital Health Networks Lung Cancer Collaborative. We network with a team of physicians that specialize in and provide state-of –the-art treatment of lung cancer. Tri-State Pulmonary Associate physicians are skilled in the latest medical diagnostic and interventional pulmonology procedures that help in early diagnosis of lung cancer. Electromagnetic Navigational Bronchoscopy and Endobronchial Ultrasound are the most progressive, up-to-date medical procedures used in the diagnosis of lung cancer. We recognize that time is essential when diagnosing and treating patients with lung cancer. Patients referred to us with suspicious lung nodules, lung masses or lung cancer is given priority in scheduling. Our physicians and office staff will work you and your staff to streamline the referral process. Once the patient is seen in our office any need procedures are scheduled at The Christ Hospital within one week, usually sooner. If needed, referrals to other health care providers are made immediately. We strive to keep the referring physician involved in the care process and provide timely updates on patient progress.

+ Interventional Pulmonology

Electromagnetic Navigation bronchoscopy (ENB or commonly called Navigational Bronchoscopy) aids in the biopsy of lung nodules (spots in the lung) that would normally be difficult to reach with minimal trauma and enables the physician to diagnose and possibly treat benign and malignant lung disease (cancer). Navigational Bronchoscopy also provides the ability to detect lung disease and lung cancer earlier, even before symptoms are evident, enhancing treatment options for patients.This technique also allows the pulmonologist to place markers to help radiation oncologists locate and target treatment to cancerous lesion sites and avoid radiating health lung tissue. In patients with poor lung capacities, these markers also assist thoracic surgeons in preforming minimally invasive lung resection.

Endobronchial ultrasound system (EBUS) is an ultrasound probe on the tip of a bronchoscope allows a doctor to biopsy lymph nodes with more precision. EBUS increases the likelihood of a correct diagnosis significantly.

Bronchoscopy is the most common interventional pulmonology procedure. Biopsies, bronchial lavage, stents, balloon bronchioplasty and removal for foreign objects are performed. For people with lung cancer or other cancers, interventional pulmonology biopsies can often accurately identify spread of cancer into lymph nodes. This can prevent unnecessary surgery or help determine the best choice for treatment.

Intrabronchial Valves is a device to control prolonged air leaks of the lung or significant air leaks that are likely to become prolonged following certain lung surgeries. The intra bronchial valve (IBV) is designed to limit airflow to parts of the lungs down past the valve, allowing mucus and air movement in the healthy portion of the lung. The valves block the injured tissue from inhaled air, reducing the leak and enabling natural healing.

Bronchial Thermoplasty is an interventional pulmonology procedure for certain people with severe asthma that can’t be controlled with medications. During bronchoscopy, a doctor applies a heat probe to the walls of the airways. The heat destroys the smooth muscle layers whose constriction contributes to asthma symptoms.

+ Pulmonary Function Testing

Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning. These tests are routinely ordered to help diagnose lung disease and to track the progression of lung diseases. These basic tests help your physician broadly classify lung diseases into a category such obstructive lung disease (COPD, bronchiectasis, etc.) or restrictive lung disease (pulmonary fibrosis, obesity, etc.)

Prior to your initial visit your pulmonologist will need a full pulmonary function test. Your pulmonologist will review your test with you at the time of your visit. These tests will be scheduled at our office either prior to your appointment or the day your appointment. Usually patients can have testing performed the same day as their appointment. Tests are then scheduled annually or as clinically indicated.

State of the art technology is used to perform patient testing. Your comfort is very important and our machine, the Medgraphics™ Platinum Elite Plethysmograph allows for maximum patient comfort. It has a patient friendly atmosphere with an intercom system that allows for easy communication between the therapist and the patient. Testing includes spirometry with bronchodilator assessment, lung volume testing and diffusing capacity testing.
Our lab manager is a Registered Respiratory Therapist (RRT) as well as a Registered Pulmonary Function Technologist (RPFT). She has in depth background in Pulmonary Function testing and Respiratory Therapy. Our technicians are Respiratory Therapist (RRT) with training in pulmonary function and are either certified (CPFT) or registered pulmonary function technologists (RPFT). All pulmonary function personnel work under the supervision a pulmonologist.

How to Prepare for the Test
• Do not eat a heavy meal before the test. A full stomach may keep your lungs from fully expanding.
• Do not smoke or due intense exercise for 4 to 6 hours before the test.
• You will get specific instructions if you need to stop using bronchodilators or other inhaled medicines. You may have to breathe in medicine before or during the test.
• Wear loose clothing that doesn’t restrict your breathing in any way.
• Avoid food or drinks with caffeine. Caffeine can cause your airways to relax and allow more air than usual to pass through.
• Wear your dentures. They help form a right seal around the mouthpiece of the machine.
• Plan to use your hearing aid during testing.

Tell the technologist if you:
• Have had a recent chest pains or heart attack
• Take medicine for lung problems such as asthma. You may need to stop taking some medicines before testing.
• Are allergic to any medicines.
• Have had a recent surgery on your eyes, chest, or belly, or if you have had a collapsed lung.

Why PFT’s are ordered:
• If there are symptoms of lung disease
• As part of a routine physical
• To monitor the progress of lung disease and the effectiveness of lung medications
• To evaluate how well the lungs are working prior to surgery.
• Pulmonary Function Tests can help diagnose asthma, allergies, chronic bronchitis, respiratory infections, lung fibrosis, bronchiectasis, COPD (Chronic Obstructive Pulmonary Disease/emphysema), asbestosis, sarcoidosis, scleroderma, pulmonary tumor, lung cancer and many other lung diseases.

What to expect
You will breathe through a mouthpiece and wear a nose clip during the testes to keep air form leaking through the mouth and nose during the test.

Depending on the test you have ordered you will inhale and exhale as instructed by the technician. You will be asked to inhale and exhale as hard and as fast as possible. You may also be asked to breathe in and out as deeply and rapidly as you can for 15 seconds.

Some tests may be repeated after you have inhaled a medicine that expands the airways in your lungs. You may be asked to breathe a special mixture of gases. These mixtures are always safe and have no health risks.

If you have body plethysmography, you will be asked to sit inside a small enclosure. It’s similar to a telephone booth with windows that allows to see out and a speaker to that you may communicate with the technologist at all time during the test. The booth measures small changes in pressure that occur as you breathe.

It is very important to follow the instructions the technologist gives you, the accuracy of your test depends upon it. Let the technologist know if you do not understand the instructions, they will be happy to explain the instructions in a manner which you can understand.

Testing can take up to one hour depending on the tests you are having.

For a healthy person, there’s little or no risk in taking these tests. If you have a serious heart or lung condition, discuss your risks with your doctor.

Test Results
Your pulmonologist will discuss your test results with you at your appointment. If you would like, test results can be sent to your primary care physician.

Different measurements that may be found on your report after pulmonary function tests include:
• Diffusion capacity to carbon monoxide (DLCO)
• Expiratory reserve volume (ERV)
• Forced vital capacity (FVC)
• Forced expiratory volume in 1 second (FEV1)
• Forced expiratory flow 25% to 75% (FEF25-75)
• Functional residual capacity (FRC)
• Maximum voluntary ventilation (MVV)
• Residual volume (RV)
• Peak expiratory flow (PEF).
• Slow vital capacity (SVC)
• Total lung capacity (TLC)