Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Bronchoscopy is a procedure during which an examiner
uses a viewing tube to evaluate a patient's lung and
airways including the voice box and vocal cord, trachea,
and many branches of bronchi. Bronchoscopy is usually
performed by a pulmonologist or a thoracic surgeon.
Although a bronchoscope does not allow for direct viewing
and inspection of the lung tissue itself, samples of the
lung tissue can be biopsied through the bronchoscope for
examination in the laboratory.
There are two types of bronchoscopes - a flexible fiberoptic bronchoscope and a rigid bronchoscope. Since the
1960s, the fiberoptic bronchoscope has progressively
supplanted the rigid bronchoscope because of overall ease
of use. In some patients, flexible fiberoptic bronchoscopy can be performed
without anesthesia, but in most cases, conscious sedation "twilight sleep") is
utilized. However, rigid bronchoscopy requires general anesthesia and the
services of an anesthesiologist. During the bronchoscopy, the examiner can see
the tissues of the airways either directly by looking
through the instrument or by viewing on a TV monitor.
Depending on the indication the examiner will choose between the flexible
fiber optic bronchoscope or the rigid bronchoscope. For example, if a patient were coughing up large amounts of blood, a rigid bronchoscope is used since it has a large suction channel and allows for the use of instruments that can better control bleeding. The vast majority of bronchoscopies are performed using the flexible fiberoptic scope because of the improved patient comfort and reduced use of anesthesia.
What are the indications for bronchoscopy?
Bronchoscopy can be used for diagnosis or treatment.
(The lists below are not meant to be all-inclusive, but are
intended to provide a greater awareness and knowledge
regarding the indications for bronchoscopy.)
Bronchoscopy is used to make a diagnosis most
commonly for these conditions:
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types of pneumothorax, spontaneous or primary pneumothorax and secondary pneumothorax. Symptoms include sudden chest pain, shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Valley fever (coccidioidomycosis) is a disease caused by the inhalation of the Coccidioides immitis or C. posadasii fungus. Symptoms are flu-like and resolve over two to six weeks. Infection typically requires no treatment, though there are many antifungal drugs to treat valley fever.
Air is pulled into the lungs when we breathe, initially passing through the mouth,
nose, and larynx (voicebox) into the trachea and continues en route to each lung
via either the right or left bronchi (the bronchial tree
- bronchi, bronchioles, and alveoli). Bronchi are formed as the lower part of the
trachea divides into two tubes that lead to the lungs. As the bronchi get farther away
from the trachea, each bronchial tube divides and gets smaller (resembling an
inverted tree) to provide the air to lung tissue so that it can transfer oxygen
to the blood stream and remove carbon dioxide (the waste product of metabolism).
Bronchitis describes inflammation of
the bronchial tubes (inflammation = itis). The inflammation causes swelling of
the lining of these breathing tubes, narrowing the tubes and promoting secretion
of inflammatory fluid.
Acute bronchitis describes the inflammation of the bronchi u...
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