Dr. Tehmina Badar is a Board Certified Pulmonologist and has been practicing Pulmonary Medicine for more than ten years. This branch of medicine deals with the causes, diagnosis, prevention and treatment of diseases affecting the lungs. This includes a wide array of diseases. Examples include chronic cough, acute and chronic bronchitis, pneumonia tuberculosis, asthma, COPD, and cancer.
Diagnosis: Evaluation of each patient begins with a thorough history and physical exam. In addition, other tests may need to be performed. Routine chest x-ray is a common screening tool. Other diagnostic tests include blood tests, lung function tests, a CT scan of the chest (an imaging study that looks at the lung in close detail), and an echocardiogram (an ultrasound evaluation of the heart). These tests are usually ordered after the first clinic visit.
Chronic Cough (cough that lasts for eight weeks or longer): is responsible for nearly 30 million clinic visits annually in the United States. Common causes include post-nasal drainage (also known as upper airway cough syndrome), GERD (gastro-esophageal reflux) and asthma. These three disorders account for 90% of all cases of chronic cough. It can also be caused by other diseases such as upper respiratory tract infections, an exacerbation of chronic obstructive pulmonary disease also known as COPD, chronic bronchitis, bronchiectasis (damaged airways with pooling of secretions), and even common blood pressure medication called ACE inhibitors. The list is lengthy but these are just a few.
Asthma: is caused by narrowing of the airways (tubes) in the lungs. This narrowing is partially or completely reversible. Symptoms include wheezing, cough, chest tightness and shortness of breath. These symptoms tend to be intermittent and are related to many factors such as viral illnesses (cold), environmental allergens, exercise, cold air, foods, stress and exercise. Identifying and avoiding “triggers” of asthma symptoms are key to preventing flare-ups. Monitoring symptoms and lung function with an “asthma diary” and peak expiratory flow rate (PEFR-the rate at which a person exhales) are also very important. The physician and patient plan of action when symptoms and/or lung function worsen are absolutely necessary to control and treat exacerbations.
Chronic obstructive pulmonary disease (COPD): a disease characterized by limited airflow during expiration (breathing out). This is usually not fully reversible and usually worsens over time. Only a minority of patients who smoke develop COPD and nearly 23% have never smoked; this suggests that there are risk factors for COPD other than smoking. These may include occupational exposure to dust or organic materials, and alpha-1 antitrypsin deficiency (a genetic disorder).
The most common causes of COPD are chronic bronchitis and emphysema: chronic bronchitis exists when the airflow obstruction is associated with a chronic cough for three months in each of two successive years. The cough must produce sputum or phlegm. Emphysema exists when the airflow obstruction is associated with damage to the air sacs in the lungs.
The history, physical exam, evaluation of lung function via pulmonary function tests, radiographic imaging are usually performed to diagnose this disease process. Treatment generally includes first and foremost, stopping smoking. Other common treatments include inhalation treatments.
Lung Cancer: This is the leading cause of cancer death in the United States and throughout the world. It is usually related to cigarette smoke but there are usually genetic links and other risk factors such as environmental exposures. The risk also increases with age.
There are many different kinds of lung cancer. A biopsy is necessary to determine the specific kind. Tissue sampling or biopsies are usually obtained by either bronchoscopy or CT-guided needle aspiration. Bronchoscopy is a procedure during which a flexible tube with a light and camera at the tip is inserted into the trachea (windpipe). This is done usually after IV medication is given to help sedate the patient. Small instruments are passed via this tube to obtain small tissue or aspirate samples. CT-guided needle aspirate biopsy is a procedure performed by a radiologist. The radiologist visualizes the tumor by performing a CT of the chest at the time of the biopsy. The radiologist numbs the skin and then inserts a thin needle through the skin of the chest into the particular area of abnormality of the lung. This is guided by the CT scan. Other diagnostic options include surgery if the tumor is small and a biopsy sample cannot be obtained in any other way. Once a diagnosis of cancer is made, an oncologist or cancer physician is usually called in consultation.
Treatment options are decided by tumor type and potential spread of the tumor. These include surgical removal, chemotherapy and/or radiation therapy. Close follow-up is paramount.