Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
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.
Physical examination will concentrate on the lung findings, but may also
include the heart and the circulatory system.
Is there an increased respiratory rate?
Is the patient short of breath just sitting in the examination room?
In addition to the ribs and the diaphragm, is the patient using the intercostal muscles (those between the ribs) and neck muscles to breathe? When used, accessory muscles cause the appearance of indrawing, where there is observable sucking in of muscles during the breathing cycle. This is normally seen in people who have just exerted themselves as the body recovers from exercise or work. In patients with emphysema it may be observed at rest.
Does the chest appear enlarged or barrel-shaped?
Does the chest cavity sound hollower than it should?
Does exhalation take longer than it should? Since the elasticity of the
lung has been lost, it takes longer for air to be forced out in the
breathing cycle.
Is the movement of the diaphragm decreased?
Is the patient cyanotic (having a blue tinge to the skin color signifying
lack of oxygen in the blood)?
When listening to the lungs, are there wheezes present, especially if the
patient is asked to exhale quickly?
Exams and tests
Oximetry
Oximetry is a non-invasive test, in which a sensor is taped or clipped onto a finger or earlobe to measure the percentage of red blood cells that have oxygen. This value is usually greater than 92%. Results less than 90% may signal the need for supplemental oxygen.
Blood Tests
A complete blood cell count (CBC) may be performed to check for an increase
in the number of red blood cells. In response to lower blood oxygen
concentrations, the body manufactures more red blood cells to try to deliver as
much oxygen as possible to cells.
Alpha-1 antitrypsin levels may be measured to look for the genetic
form of emphysema.
An arterial blood gas test will measure the amount of oxygen and carbon
dioxide in the blood and combined with other measurements can help the healthcare provider decide whether the body has been able to adapt to the lower oxygen
concentrations in the body. In some laboratories, the arterial blood gas result
will include a carbon monoxide percentage, most often found in the body because
of smoking. For each hemoglobin molecule that has carbon monoxide attached,
there is one less available that can carry oxygen.
The arterial blood gas can also give parameters to establish the diagnosis of chronic respiratory failure. When the measured oxygen level drops below 60 mmHg (millimeters of mercury) and the carbon dioxide level rises above 50 mm Hg, the diagnosis of chronic respiratory failure can be made.
Radiology
A plain chest X-ray may show lungs that have become too inflated and have lost normal lung markings, consistent with destruction of alveoli and lung tissue.
A CT scan can reveal more detail regarding the amount of lung destruction but is not a normal part of the evaluation of patients with emphysema.
Pulmonary Function Tests
Pulmonary function tests or spirometry, can measure the air flow into and out
of the lungs and be used to predict the severity of emphysema. By blowing into a
machine, the amount of air that is moved and how quickly it moves can be
calculated and provides information about lung damage. Results are compared to a
"normal" person of the same age, sex, and size.
Some measurements include:
FVC (forced vital capacity): the amount of air that can be forcibly
exhaled after the largest breath possible.
FEV1 (forced expiratory volume in 1 second): the amount of air that is
forcibly exhaled in 1 second. Even though total air exhalation may be less
affected, as the lung loses its elasticity, it takes longer for the air to
get out and FEV1 becomes a good marker for disease severity.
FEV (forced expiratory volume): can be measured throughout the exhalation cycle often at 25%, 50%,
and 75% to help measure function of different sized bronchi and bronchioles.
PEF (peak expiratory flow): maximal speed of air during exhalation.
DLCO (diffusion capacity): measures how much carbon monoxide can be
inhaled and absorbed into the bloodstream within a period of time. A small
amount of tracer carbon monoxide is inhaled and then quickly exhaled. The
amount of carbon monoxide in the exhaled air is measured and determines how
well the lungs work in absorbing the gas. This helps determine and measure
lung function.
What are the stages of emphysema?
Emphysema staging helps determine how much lung damage is present and how
severe it is. The Global Initiative for Chronic Obstructive Lung Disease (GOLD)
uses FEV1 measurements to help with this determination:
Stage
FEV1
I = mild
greater than or equal to 80% predicted
II = moderate
less than 80%, greater than 50% predicted
III = severe
Less than 50%, greater than 30% predicted
IV = very severe
Less than 30% predicted, or less than 50% in chronic respiratory failure
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.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
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.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
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).
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Premature ventricular contractions (PVCs) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
Marfan syndrome is hereditary condition affecting connective tissue. A person with Marfan syndrome may exhibit the following symptoms and characteristics: dislocation of one or both lenses of the eye; a protruding or indented breastbone; scoliosis; flat feet; aortic dilatation; dural ectasia; stretch marks; hernia; and lung collapse. Though there is no cure for Marfan syndrome, there are treatments that can minimize and sometimes prevent some complications.
Pulmonary hypertension is an abnormal elevation of the pressure in the pulmonary circulation caused by the constriction of the blood vessels that supply blood to the lungs. Shortness of breath and dizziness are symptoms of pulmonary hypertension. Treatment involves diuretics, blood thinners, calcium channel blockers, and using supplemental oxygen to increase blood oxygen levels.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Ehlers-Danlos syndromes are genetic disorders that include symptoms such as loose joints, tissue weakness, easy bruising, and skin that stretches easily. There are seven types of Ehlers-Danlos syndromes: Classical type, Hypermobility type, Vascular type, Kyphoscoliosis type, Arthrochalsia type, Dermatosparaxis type, and Tenascin-X Deficient type. Treatment for Ehlers-Danlos syndromes depends on which symptoms are present.
Smoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.
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.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Chagas disease is an infection caused by the T. cruzi parasite. Symptoms of Chagas disease include rash, swollen lymph nodes, fever, fatigue, nausea, vomiting, and the Romaña sign. An ELISA test is used to diagnose Chagas disease. Treatment depends upon the phase of the disease and the patient's age.
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath, wheezing, weight loss, respiratory infections, fatigue, vision abnormalities. Advanced lung disease from alpha-1 antitrypsin deficiency include emphysema. Liver damage from alpha-1 antitrypsin deficiency causes a swollen abdomen, swollen legs or feet, and jaundice.
Nicotine is delivered to the brain through smoking, chewing, or sniffing tobacco. Nicotine is an addictive agent. Common names for nicotine products include smokes, cigs, butts, chew, dip, spit, or snuff. Habitual nicotine use leads to many debilitating medical conditions.
The lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. Eliminating carbon dioxide from the blood is important, because as it builds up in the blood, headaches, drowsiness, coma, and eventually death may occur. The air we breathe in (inhalation) is warmed, humidified, and cleaned by the nose and the lungs.
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
Lungs RSS
Healthy Living Tips
This site complies with the