Comprehensive pulmonary care for the Gulf Coast community and beyond.
To us, breath is life. Our team is driven to find solutions to all disorders that affect the precious ability to breathe. It’s our duty and our joy to help patients of all circumstances improve their quality of life through personalized pulmonary care.
Our talented physicians, nurse practitioners and physician assistants offer a full and comprehensive range of pulmonary care. Some of the conditions we treat include asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pneumonia, bronchitis and interstitial lung disease. While all of our physicians treat a full range of pulmonary and pulmonary-related conditions, some of our physicians specialize in very specific pulmonary and critical care conditions. Learn more about the specializations of each of our physicians here.
Pensacola Lung Group is proud to be recognized as a nationally accredited Adult Cystic Fibrosis Center by the Cystic Fibrosis Foundation.
Pulmonary issues don’t always wait for a scheduled appointment.
In order to provide patients with quicker access to physicians, team and treatments and meet the urgent demands of many pulmonary issues, we offer a walk-in care clinic for established Pensacola Lung Group patients.
All patients who are current with the practice can visit the walk-in clinic Monday through Thursday from 8am-11am—no appointment necessary. Patients must have been seen within the previous year to qualify for this service.
Any disruptions to our services will be provided on our answering machine. For more information on our walk-in clinic, please call (850) 477-9253.
What is Acute Bronchitis?
Acute bronchitis is also known as a chest cold. It’s a form of lower respiratory tract inflammation affecting the air tubes (bronchi) of the lungs. It is short-term, usually coming on suddenly and lasting for three to 10 days, while chronic bronchitis is usually caused by constant irritation.
People of all ages can be affected by acute bronchitis. It is usually caused by a virus, which attack the lining of the bronchial tree and cause inflammation. The symptoms of acute bronchitis can include:
- Sore throat
- Cough that brings up a clear, yellow or green mucus
- Chest congestion
- Shortness of breath
- Body aches
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/acute-bronchitis/.
Advanced Lung Disease and Transplantation
By advanced lung disease (ALD) we mean any lung disease that has advanced, or worsened, to the point where the patient is severely disabled and/or faces death from the disease in a short period of time.
This state can occur in all three basic types of lung diseases:
- Obstructive Lung Diseases are characterized mainly by blocked airways. Examples that can lead to ALD include chronic obstructive lung disease (COPD), and bronchiectasis (from, for example, cystic fibrosis).
- Interstitial Lung Diseases (ILD) include many primary diseases of the lung, like Idiopathic Pulmonary Fibrosis (IPF). But ILD can also result from diseases like Systemic Lupus Erythematosus (SLE) that can engulf the lung tissue in it’s systemic destruction.
- Pulmonary vascular diseases affect the blood vessels that go through the lung to pick up oxygen. Primary Pulmonary Hypertension, for example, is a disease that causes progressive narrowing of these blood vessels, and progressively low oxygen in the blood.
Some of these diseases progress to a point of ALD, in spite of best standard medical practice. Generally, ALD is present when the lung function has dropped below about a third of normal function. At that point, most patients require oxygen and are limited in what they can do.
Options for ALD are limited, but include ongoing best treatment of the causative disease, and support with oxygen, as well as pulmonary rehabilitation. We have hope that some novel treatments such as stem cells will eventually help us to rebuild damaged lungs. However, those therapies are still in the research phase, and are least 10-15 years from practical use. Meanwhile, however, lung transplantation is proving ever more effective for ALD. Lung transplantation is still reserved for a select few, but can be lifesaving and restore quality of life.
Alpha-1 Antitrypsin (AAT) Deficiency
What is Alpha-1 antitrypsin (AAT) deficiency?
Alpha-1 antitrypsin (AAT) deficiency is a genetic disorder that is passed on in families and affects the lungs, liver and skin. When this condition affects the lungs, it causes emphysema, a part of COPD (chronic obstructive pulmonary disease) along with chronic bronchitis.
Symptoms related to the lung include shortness of breath, wheezing, chronic bronchitis, recurring chest colds, less exercise tolerance, year-round allergies, and bronchiectasis.
Symptoms related to the liver include unexplained liver disease or elevated liver enzymes, eyes and skin turning yellow (jaundice), swelling of the abdomen or legs and vomiting blood.
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/alpha-1-antitrypsin-deficiency/.
What is Asbestosis?
Asbestosis is a chronic lung condition that is caused by prolonged exposure to high concentrations of asbestos fibers in the air. Asbestos is a natural mineral product that is resistant to heat and corrosion. Before the federal government began regulating its use in the 1970’s, it was widely used in construction projects.
The effects of long-term exposure to asbestos typically don’t show up for 10 to 40 years after initial exposure. Asbestosis signs and symptoms can include:
- Shortness of breath
- A persistent, dry cough
- Loss of appetite with weight loss
- Fingertips and toes that appear wider and rounder than normal (clubbing)
- Chest tightness or pain
Asbestosis is a chronic disease with no cure, but steps can be taken to improve quality of life.
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asbestosis/.
What is asthma?
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.
For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma is diagnosed through one of more breathing tests known as lung function tests.
- Difficulty breathing
- Breathing through the mouth
- Fast breathing
- Frequent respiratory infections
- Rapid breathing
- Shortness of breath at night
Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/.
What is bronchiectasis?
Bronchiectasis is a chronic condition where the walls of the bronchi are thickened from inflammation and infection. People with bronchiectasis have periodic flare-ups of breathing difficulties, called exacerbations. Bronchiectasis is often part of a disease that affects the whole body. It is divided into two categories: cystic fibrosis (CF)-bronchiectasis and non-CF bronchiectasis.
The most common symptoms of bronchiectasis are:
- Breathlessness or difficulty breathing
- Problems with your sinuses
- Coughing up yellow or green mucus every day
- Shortness of breath that gets worse during exacerbations
- Feeling run-down or tired, especially during exacerbations
- Fevers and/or chills, usually developing during exacerbations
- Wheezing or a whistling sound while you breathe
- Coughing up blood or mucus mixed with blood, a condition called hemoptysis
Bronchiectasis is diagnosed through a medical exam which may include a chest X-ray, CT scan, blood tests and lung function tests. Occasionally, your physician may suggest a bronchoscopy, in which a camera in a narrow tube is used to look inside your lungs.
While the condition cannot be cured, treatment can help reduce the number of lung infections that people with bronchiectasis are prone to. Many people manage very well this this chronic condition.
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/bronchiectasis/.
Chronic Obstructive Pulmonary Disease (COPD)
What is COPD?
Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a chronic lung disease that makes it hard to breathe. The disease is increasingly common, affecting millions of Americans, and is the third leading cause of death in the U.S. The good news is COPD is often preventable and treatable.
Many people don’t experience symptoms of COPD until later stages of the disease. The main cause of COPD is smoking, but nonsmokers can get COPD, too.
Symptoms can include:
- Chronic cough
- Shortness of breath while doing everyday activities (dyspnea)
- Frequent respiratory infections
- Blueness of the lips or fingernail beds (cyanosis)
- Producing a lot of mucus (also called phlegm or sputum)
Don’t wait for symptoms to become severe because valuable treatment time could be lost. Early detection of COPD is key to successful treatment.
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/.
What is cough?
Coughing is an important reflex that helps protect your airway and lungs against irritants. Occasional coughing is normal, but a persistent cough or one that is associated with other symptoms might be a sign of a more serious condition. Waiting to hear from the client for the patient portal link, so I will let you know as soon as they provide that for me. Shared the new home page a few minutes ago so you should see it soon.
Learn more about what causes coughing, when it could be a problem, diagnosing and treating a cough and how to manage a cough while your doctor is treating the cause by visiting http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/cough/.
Cystic Fibrosis (CF)
What is CF?
Cystic Fibrosis (CF) is a progressive, genetic disease that causes thickened mucus to form in the lungs, pancreas and other organs. In the lungs, this mucus blocks the airways, causing lung damage and making it hard to breathe. CF is a life-threatening condition, but thanks to advances in treatment and care, the average life expectancy has been steadily increasing and quality of life has improved.
Symptoms of CF can include:
- Persistent coughing, at times with phlegm
- Frequent lung infections including pneumonia or bronchitis
- Wheezing or shortness of breath
- Poor growth or weight gain in spite of a good appetite
- Frequent greasy, bulky stools or difficulty with bowel movements
- Male infertility
The type of cystic fibrosis and severity of symptoms vary widely from person to person, and treatments are customized to each individual’s unique circumstances.
For more information, visit http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/cystic-fibrosis/.
Lung Disease and Exercise
It used to be that patients with lung disease were discouraged to exercise. They were told to live quietly and not strain.
That all changed with research into the benefits of exercise for chronic lung disease patients, beginning in the 1960s. Today it is widely recognized that one of the most beneficial things a patient with lung disease can do for himself or herself is regular exercise.
The types and benefits of regular exercise for lung disease are several.
First, “aerobic exercise”, that gets the heart and respiratory system working over an extended time is absolutely the best type of exercise for lung patients. Its primary benefit is to improve a patient’s endurance and lessen patient’s sensation of shortness-of-breathe (SOB). Better endurance and less breathing difficulty allows patients to do more and feel better. Examples of these exercises are walking, treadmill, bicycling, stationary cycling, swimming, water aerobics, and upper-lower body exercisers like Nordic Track, etc. Fitness experts often recommend target heart rates for specific periods and other complicated formulas. But for lung patients, we recommend only a few simple rules to go by:
- First, frequency and consistency matter. Every day, for aerobic exercise, is best. But three days a week, at least, will really help.
- Pace yourself, and take breaks. Lung disease patients are limited by how much air they can get in and out of their lungs and how much oxygen they can put into their blood. When exercising, muscles pull oxygen out of the blood. When muscles pull oxygen out of the blood faster than lungs can put it in the blood, an oxygen deficit occurs. That is the oxygen level in the blood goes down below a critical level (usually an oxygen saturation of the blood of 90%). When that occurs, patients feel very SOB and the low blood oxygen is not good for the body. So, to avoid that situation we recommend slowing down or taking a break if feeling more than mildly SOB. Most patients eventually, through trial and error, figure out the pace at which they can exercise effectively and comfortably. The pace is the exercise level at which the lungs can move enough air in and out and put enough oxygen in the blood to support the exercise. Pace is different for everybody, and may change over time. If you have advanced lung disease, you may need a pulmonary rehab program to help you determine your appropriate pace.
- We recommend the time goal for aerobic exercise to be 30 minutes. Certainly longer can be done and, for the most part, helps even more. However, lung patients may be able to go only a short time or distance, before needing a rest. That is perfectly OK. We recommend that patients not get over short-of-breath, and get themselves into trouble. Use your common sense, and stop for a break when you feel that you are getting more than mildly stressed. Chronic lung disease patients often need several breaks to get all of their aerobic work in.
- It is not uncommon for patients to be only able to do a few minutes when they start. Again, that is fine. Don’t get discouraged, but set as a goal to increase your time or distance just a little every week.
- If you need oxygen to exercise – do it. It does not diminish the benefit of exercise at all. In fact, it is far better to exercise with oxygen than not to exercise with no oxygen! Consult your doctor as to how much oxygen to use.
Second, strengthening exercises build individual muscles and muscle groups, and can help patients with chronic lung disease to be more “functional”. In advanced lung disease, muscle proteins (building blocks that muscles are made of) are sometimes broken down by the disease process itself, and also by a process called “disuse atrophy”. Disuse atrophy occurs when you don’t use muscles. If you don’t use muscles you naturally lose muscle size and strength. Lung patients often avoid tasks that require some muscle exertion, because such activities make them “short-of-breathe”. Lack of muscle use results in muscle loss, which causes further decreased ability to work and exercise. For example, if a lung patient stops doing regular household chores, say vacuuming, because it makes him or her “winded”, then eventually the patient loses some arm, back and leg strength that comes from the muscle exercises of vacuuming. Less strength means that the patient may shy away from some other tasks, such as cooking, that involve some lifting or stirring, which they are no longer strong enough to do. So you can see that lung disease can lead to a cycle of muscle loss followed by more disability, followed by more muscle loss, etc. A situation develops whereby a patient is less and less able to do what they need and want to do. Activity level declines, and so does quality of life. Strengthening exercise can help break the downward spiral. So again a few simple rules:
- We recommend exercises that work several muscle groups at once, such as those use medicine balls.
- Exercising individual muscles or a small number of muscle groups is fine and good, but we do recommend a balanced workout of the upper, lower, and core muscle groups. This approach is best for optimizing function.
- Light weights and more repetitions are better than heavy weights and fewer repetitions.
- We recommend using a personal trainer, or structured strength building classes from certified professionals and programs, at least to begin with. It may not be financially feasible for everyone to do so. But a few sessions with trainer can help you set up your own program, and often the YMCA, or other community based centers, have very inexpensive programs.
- Pacing and breaks apply here too.
The Importance of an Active Lifestyle
We also encourage our patients to be as active as they can. An active lifestyle, outside of formal exercise time, is good medicine as well. The more active patients are, the more they are able to do, and in general, the more they are able to enjoy life.
Finally, for patients with advanced lung disease, especially those needing oxygen, we strongly recommend a “pulmonary rehab” program to get started.
Oxygen (O2) is the primary fuel for the body. Every organ needs O2 to work. Just like gas for a car, if your body’s O2 level is too low, your organs won’t work. You won’t be able to think clearly, your heart may not be able to pump as well, your kidneys will not be able to filter and clean your blood effectively, etc. But unlike gas for a car, O2 is not just necessary for your body to perform. If a car runs out of gas it stops running. But it does not start to fall apart. It just sits there unable to move. If your body O2 level gets too low your organs start to actually shut down and even begin to be injured by lack of oxygen. Eventually, your organs can be permanently damaged or even die if O2 is low enough, long enough.
Patients with advanced chronic lung disease often have low blood O2 levels. If it is severely low, they get distressed and need immediate aggressive medical attention. But if it is mildly, or even moderately low, patients can often function, though usually not optimally. Most times patients with mild to moderately low oxygen feel bad. But occasionally they don’t, or at least they are not aware that they could be feeling much better if their oxygen was good.
We know from scientific studies that advanced lung disease patients with low O2, defined as a blood oxygen saturation of below 90%, benefit greatly by using supplemental O2 gas. In fact, these patients live significantly longer if they use O2 for at least 15 hours per day. As you might expect, hypoxemic patients (patients with low blood oxygen) feel better, are able to do more, and in general have better health, with oxygen use. So that is why physicians prescribe O2 for patients with advanced lung disease and low O2.
Oxygen is non-addictive. That is, using O2 does not make your lungs weak, or dependent upon the O2.
O2 use is really quite safe in general, but there are some basic precautions to take with medical O2 in the home. First, it is very important to know that O2 is flammable. So fire and ignition materials should be kept out of the immediate vicinity (at least 5 feet) of an O2 gas source. Naked wires or other fire hazards, as well, should be kept away from oxygen. Second, O2 delivery systems should be kept in well ventilated areas. By doing so, there is very little risk of raising the oxygen content of a room or building significantly, or enough to increase the chance of a general fire.
Oxygen for patients is usually ordered by physicians for patients meeting criteria, and delivered to the patient by a medical oxygen supply company. Nearly universally, patients inhale the O2 gas from a “nasal cannula”. Small tubing that delivers O2 into the nostrils. The gas travels up through the nose and then down into the back of the throat where it is inhaled without any conscious effort by the patient. Just normal breathing brings the extra oxygen into the lungs. The tubing is hooked up to one of several types of O2 gas supply sources. The O2 can come from a tank of concentrated oxygen, an oxygen concentrator, or from liquid oxygen.
- Concentrated O2 gas – this is the oldest system of O2 for the home. Compressed O2 gas comes in various sized metal canisters. Large canisters are for use in the home and small canisters can be taken portable. The gas is let out into the oxygen tubing through a valve, with a “flow regulator” that determines how much comes out of the tank in liters per minute. New tanks get delivered to the home when the old tanks run low on O2.
- Liquid oxygen – these systems run on liquid oxygen. A storage tank is refilled periodically with cold oxygen – which is in liquid form. When warmed up the liquid O2 turns into a gas that can come out of tubing. There are now portable systems that use liquid O2. They are the lightest of the portable O2 systems.
- Oxygen Concentrator – this system runs on electricity. It pulls oxygen from the air and concentrates it to be let out into the oxygen tubing that goes to the patients. Traditionally this has been a workhorse of home O2. Recently light weight, battery operated systems have come out for portable use. These systems do not need to be serviced with O2 gas or liquid oxygen.
The O2 gas flow to nasal cannula can come from the oxygen source as continual flow, or intermittent flow. The usual way to deliver O2 is a continual flow from the source. For example, a common continual flow rate of gas through the nasal cannula is 2 liters of O2 gas per minute. This is happening through all parts of the respiratory cycle, even when patients are not breathing in. This may seem wasteful to have O2 flowing when not breathing in. Indeed, some of the O2 gas goes into the surrounding air. But also, some of the O2 gas, between breathes, goes into the nose and upper airway, and forms a “reservoir of oxygen”. When the patient does take a breath, a higher concentration of O2 is inhaled from this reservoir, in addition to the O2 from active flow. Intermittent O2 gas flow is designed to conserve O2 gas, especially for the portable systems, that have a limited O2 supply, or a limited battery life. There are several types of intermittent flow systems, but they all deliver O2 flow timed to inspiration. Theoretically the intermittent flow O2 systems can do as good a job at supplying O2 as the continuous systems. The reality is, though, that many patients just don’t do as well with the intermittent system.
The flow rate o f oxygen is usually adjusted to increase or decrease the amount of oxygen that patients are receiving. Standard oxygen sources can deliver from ½ liter per minute of O2 to 5 liters/minute (L/min). Every liter/minute of oxygen increases the percentage of O2 the patient breathes by 3 – 4 %. Room air is 21% O2. So if a patient is on 4 L/min O2 flow, then he or she is breathing air that is about 33 – 37% O2. The normal practice is to adjust O2 flow for patients to be comfortably above an oxygen blood saturation of 90% at rest. It is often, however, the case that patients need more oxygen for exercise. So for example a patient may use 2 L/min O2 at rest, but need 4 L/min with exertion.
Occasionally, for patients needing high flow rates we consider two other devices to increases the amount of oxygen a patient can get. One is an “oximizer”. These devices are, essentially, mini O2 reservoirs, that hang off the nasal cannula, and allow the patient a larger source of potential oxygen when taking a deep breath. A “transtracheal oxygen cannula” is a cannula, placed directly into the trachea that delivers O2 gas. The cannula is placed through a small tunnel created by an ENT surgeon, through the front of the neck, directly into the main breathing tube called the trachea. These devices have been fraught with complications and our practice, does not use them any longer.
Lastly, many patients don’t like to be seen wearing oxygen. They find it embarrassing, and fear it to be socially isolating. Well, that’s where attitude makes all the difference. Think of oxygen as just another tool in your tool belt to do what you need to do. Some of us need medicines to do what we need to do, some need a knee brace. We all need cars, busses, or trains to get around. Well oxygen is just gas for the car, in some lung diseases. Don’t let O2 limit you, let it take you where you want to go.
Pharmaceutical Support Programs
Pensacola Lung Group patients may take advantage of the following Pharmaceutical Support Programs:
- Advair – www.advair.com
- Asmanex- www.asmanex.com
- Chantix – www.chantix.com
- Dexilant – www.dexilant.com
- Dulera – www.dulera.com
- Flovent –www.myflovent.com
- Foradil – www.foradil.com
- Nazacort – www.nazacortaq.com
- Nexium – www.nexium.com
- Nuvigil – www.nuvigil.com
- Omnaris – www.omnaris.com
- Pro Air HFA – www.proairhfa.com
- Proventil- www.proventilhfa.com
- QVAR – www.qvar.com
- Singular – www.singulair.com
- Spiriva – www.Spriva.com
- Symbicort- www.mysymbicort.com
- Ventolin HFA – www.Ventolin.com
- Veramyst- www.veramyst.com
- Xopenex- www.xopenex.com
Pulmonary Rehab is a program of exercise, education and training for patients with chronic and advanced lung diseases, such as chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF).
It is designed to help patients improve their functional status and quality of life. It is done, usually, at either a free-standing pulmonary rehab facility or at a hospital or clinic multi-use rehab facility. A multi-disciplinary team of professionals guide patients through the usually 8-12 week long program, consisting of 2-3, one to two hour sessions, per week.
Pulmonary rehab, as a distinct program for patients with advanced lung disease, was first conceived and developed by Dr. Thomas Petty, a giant in the world of pulmonary diseases, at The University of Colorado in the 1960s. The program spread, and by the 1990s enough scientific evidence of its effectiveness had accumulated that all the major societies for the treatment of lung diseases, including The American Thoracic Society, and the American College of Chest Physicians, strongly endorsed the program. Around the year 2000 Medicare approved it as therapy for a number of advanced lung diseases, as well.
Pulmonary rehab is designed to improve several physical problems that arise as a result of advanced lung disease. Rehab program exercises specifically improve peripheral muscle weakness, and respiratory muscle weakness. Advance lung disease, itself, causes muscle protein breakdown. Additionally, the lack of muscle exercise, because lung function can’t support exercise (I’m too short of breath to exercise), causes muscle loss. A major focus of rehab is cardio-pulmonary conditioning. That is, “aerobic” exercises that improve endurance. Such exercises include walking, stationary cycling, etc. These exercises are often done while using oxygen. Therapist will train patients on when and how much oxygen to use when exercising.
Pulmonary rehab also trains patients in optimal breathing techniques such as “pursed lip breathing”. Occupational therapists teach patients about “energy conservation techniques”, and even physical equipment that can be used by the lung patient to extend and improve day to day function.
Nutritionists sometimes counsel patients about strategies to combat the weight loss and nutritional deficiencies that occur in some chronic lung diseases. Alternatively, nutritionists can counsel patients about excess weight that contributes to functional limitation.
Social workers are sometimes involved to help patients optimize their lifestyles, and living situations, toward a situation that best fits their lung disease.
We have found that one of the unexpected benefits of rehab is that patients discover that they are not alone in their struggles. At rehab patients meet others with similar challenges. These other patients and the overall positive and supportive environment of a rehab center can be very educational and encouraging to a patient with lung disease.