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Pulmonary Medicine
Programs and Specialties

Lung and Airway Conditions

At Brigham and women’s Pulmonary Associates at Care New England, you gain access to top-quality providers, services, advanced technology, and innovative treatments. Patients work with a multidisciplinary team of pulmonologists and specialists from across Care New England to address their condition or situation.

Conditions treated include:

Lung Infections

Patients who require surgery benefit from an integrated collaboration with the Care New England Pulmonary Medicine team and other specialists at Care New England. Pulmonary and critical care medicine services are provided in the outpatient setting or inpatient at Kent Hospital where strict attention is given to infection control while working to provide a care plan to address a diagnosis.

Conditions treated include:

Lung Tumors and Cancer

Care New England provides some of the best regional care for patients with tumors and cancer, including lung cancer. We are dedicated to educating patients about their specific disease and treatment options so they can make informed decisions. The Lung Health, Lung Cancer Screening & Lung Nodule Clinic provides a comprehensive approach to addressing concerns for these patients from medical treatment to tobacco use cessation.

Conditions treated include:

Pulmonary Vascular Disease

Pulmonary vascular disease encompasses a broad group of conditions that affect the blood vessels between the lungs and the heart.

Some of these diseases include:

  • Chronic thromboembolic pulmonary hypertension
  • Hepatopulmonary syndrome
  • Pulmonary embolism
  • Pulmonary hypertension

Care New England has a comprehensive and well-integrated network of providers to provide care and treatment for patients with pulmonary vascular disease. Providers from Brigham and Women’s Cardiovascular Associates at Care New England and Brigham and Women’s Thoracic Surgery Associates at Care New England work with their pulmonary and sleep medicine colleagues at Care New England to ensure coordinated and comprehensive care.

Learn more about treatment options:

Thoracic Surgery
Vascular Clinic at Kent Hospital

End-Stage Respiratory Disease

The Pulmonary Medicine team at Care New England offers a special multidisciplinary team of physicians, surgeons, and nurses to care for our sickest patients, including those in respiratory failure.

The experienced team provides a full range of advanced respiratory care, from ventilator and oxygenation support to lung transplantation surgery.

The transplant surgical team supports patients throughout the transplant process. The collaboration with other Care New England medical services, including with the Brigham and Women’s Thoracic Surgery Associates at Care New England, provides patients and their families and care experience that involves full engagement, communication, and compassion.

Our team also has access to extensive ancillary services to help support patients through the management of their disease, including outpatient rehabilitation programs through Kent Hospital.

Conditions that may lead to End Stage Respiratory Disease include:

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Pulmonary Conditions

Asthma

What is asthma?

Asthma is a chronic lung condition that involves the airways. Something triggers the airways to swell and inflamed and become narrow. The muscles tighten, and the airways become too narrow so that air can't move in and out of your lungs.

Risk factors

There are no exact causes, but there may be inherited factors or environmental triggers. Some might include dust, pollen, or smoke, or such conditions as a respiratory infection or gastroesophageal reflux disease.

Symptoms

  • Cough
  • Fatigue
  • Shortness of breath
  • Tightness in chest
  • Wheezing

Call 911 or receive emergency assistance if the following symptoms occur during an asthma flare-up:

  • Breathing difficulty
  • Lightheadedness or dizziness
  • Lips or fingers turn blue
  • Walking or talking is difficult

Tests and Treatment

Diagnosis is accomplished by an examination by a physician of:

  • Lung function
  • Tests to rule our lung disorders

Tests might include:

  • Allergy test – Skin or blood test
  • Exercise test
  • Imaging test – X-ray or CT scan
  • Spirometry – Test used to measure the amount of air being exhaled and how quickly.

There are ways to manage asthma, including avoiding triggers and exercising moderately, but there are also medications that can be prescribed:

Fast-acting medications

  • Anticholinergics
  • Beta-agonists – Most common quick-relief medications
  • Corticosteroids (oral)

Long-term medications

  • Beta-agonists (inhaled
  • Biologics
  • Bronchodilators
  • Corticosteroids (inhaled)
  • Cromolyn
  • Leukotriene modifiers
  • Theophylline
Bronchitis or Bronchiectasis

What is bronchitis?

Bronchitis is inflammation of the breathing tubes called bronchi. The inflammation causes too much mucus buildup where it does not drain from the lining of the airway, which can cause infections. Bronchitis is categorized as acute or chronic.

The condition is considered chronic if there are a cough and mucus for at least three months during two consecutive years.

Risk factors

Smoking cigarettes or other products is a key cause, but it can also be caused by air pollution or the work environment. It also can be accompanied by another lung disease such as:

  • Asthma
  • Lung cancer
  • Pneumonia
  • Pulmonary emphysema
  • Scarring of the lungs
  • Tuberculosis
  • Upper respiratory infections

Symptoms

  • Chest discomfort
  • Cough (hacking, sharp or also propelling of mucus from the throat)
  • Shortness of breath
  • Wheezing

In severe instances of chronic bronchitis, symptoms such as blue fingernails, lips or skin, swollen feet, or heart failure may occur

Diagnosis

A full examination will have to be done by a provider.

Tests and treatment

Tests might include:

  • Peak flow monitor – measures the speed at which air can be exhaled out of the lungs
  • Spirometry – most common lung function test

Other tests might include a CT scan, x-ray, pulse oximetry, Nasal Nitric Oxide measurement, or a blood test.

Treatment may include lifestyle changes, such as quitting smoking, more exercise, hydration, diet, and vaccines, including the pneumococcal vaccine against pneumonia.

There are several medications:

  • Antibiotics
  • Bronchodilators
  • CF-related medications to improve gene function that causes the disease
  • Mucus-thinning medications
  • Surgery may also be an option, such as a lobectomy to remove part of the lung affected, as well as lung transplantation.
Chronic Obstructive Pulmonary Disease and Emphysema

What are Chronic Obstructive Pulmonary Disease and Emphysema?

It is a broad range of diseases, that includes emphysema, where air sacs, called alveoli, become:

  • Collapsed
  • Destroyed
  • Narrowed
  • Overinflated
  • Stretched

The damage cannot be reversed. Holes are created in the tissues of the lower lung.

Risk factors

  • Air pollution
  • Alpha 1-antitrypsin – inherited form of the disease
  • Smoking

Symptoms

  • Cough
  • Rapid breathing
  • Mucus or sputum
  • Shortness of breath
  • Wheezing

Other symptoms might include:

  • Anxiety
  • Depression
  • Fatigue
  • Heart difficulties
  • Sleep problem
  • Weight loss

Diagnosis

An examination is required, but some tests ordered may include:

  • Peak flow monitor – measures the speed air can be exhaled out of the lungs
  • Spirometry – most common lung function test

Other tests might include a CT scan, x-ray, blood tests, electrocardiogram, or a sputum culture.

Treatment

  • Antibiotics for infections
  • Avoid environmental factors such as pollution and smoke
  • Endobronchial valve device – Minimally invasive system to treat severe emphysema
  • Medicine such as bronchodilators
  • Nutritional support
  • Oxygen therapy
  • Pulmonary rehabilitation program
  • Surgery to remove the damaged area of the lung
  • Vaccines such as the flu or pneumococcal vaccines
Cryptogenic Organizing Pneumonia

What is cryptogenic organizing pneumonia?

This condition is a form of pneumonia when the small airways, also called bronchioles, the air sacs, or alveoli, and the walls of the small bronchi are inflamed. If untreated it can cause hospitalization. The causes of this disease are unknown.

Instances of this condition are higher in individuals diagnosed with inflammatory diseases such as:

  • Rheumatoid arthritis
  • Scleroderma
  • Systemic lupus erythematosus

Symptoms

  • Breathing difficulty
  • Cough (persistent and dry)
  • Fatigue
  • High fever
  • Shaking, chills
  • Shortness of breath
  • Weight loss

Diagnosis

  • Blood tests
  • Bronchoscopy
  • CT scan
  • Lung biopsy
  • Pulmonary function tests
  • Pulse oximetry
  • Sputum culture
  • Thoracentesis and pleural fluid culture

Medication

  • Corticosteroids
  • Cytotoxic medications
Cystic Fibrosis

What is cystic fibrosis?

Cystic fibrosis is a condition where mucus builds up throughout the body and damages several bodily systems, including the respiratory, digestive, and reproductive systems. It is life-threatening and often is diagnosed in childhood. Caused by a mutation of a gene, it cannot be cured. Due to research and improved healthcare methods, patients are living longer lives with better quality of life.

Risk factors

Cystic fibrosis is an inherited disease. The genes have to come from both parents. Testing is recommended for anyone with a family history.

Symptoms

  • Abnormalities in sweat and mucus glands
  • Mucus that clogs organs inside the body

Diagnosis

It is normally diagnosed through screening at birth, but there are several tests that can be done during childhood:

  • Blood tests
  • Genetic tests
  • Pulmonary function
  • Stool test

Treatment and procedures

There is no cure for cystic fibrosis.

There are ways to manage the symptoms of cystic fibrosis for patients to live longer and have a better quality of life, including managing respiratory conditions associated with the disease through exercise, medication, antibiotics, and physical therapy, as well as through diet, nutrition, and surgery.

Interstitial Lung Disease

What is interstitial lung disease?

Interstitial Lung Disease refers to a broad group of more than 200 different lung disorders that cause lung inflammation or scarring or fibrosis. Common symptoms include shortness of breath and a persistent dry cough.

Interstitial lung disease can be classified into idiopathic interstitial types of pneumonia, which has no known cause, those associated with connective tissue diseases, such as rheumatoid arthritis, lupus, and those related to environmental and occupational exposures to substances like asbestos, etc.

Risk factors

  • Autoimmune diseases
  • Chemotherapy and radiation
  • Drugs or medication
  • Environmental factors
  • Family history
  • Smoking

Symptoms

  • Chest pain
  • Dry cough
  • Fatigue
  • Shortness of breath or difficulty breathing
  • Weight loss

Diagnosis

  • Bronchoscopy
  • Echocardiogram
  • High-resolution computerized tomography scan
  • Pulmonary function tests
  • Thoracic surgery
  • Walking test
  • X-ray

Treatment

Lung scarring is permanent, but the symptoms can be managed in order to improve lung function.

There are several treatment options:

  • Lung transplant
  • Medication
  • Oxygen therapy
  • Pulmonary rehabilitation
  • Thoracic surgery
Sarcoidosis

What is sarcoidosis?

Sarcoidosis is a disease that can cause inflammation and occurs in the lungs and lymph nodes. It can also occur in other organs of the body.

Sarcoidosis in the lungs causes small lumps of inflammatory cells in the lungs called granulomas. This has an impact on lung function, but they can heal on their own, but they can also remain inflamed, and scarring then occurs, which is called fibrosis.

Risk factors

There are no known causes, but bacteria, chemicals, viruses, or other environmental factors may cause the disease, as well as genetic factors.

Symptoms

  • Chest pain
  • Dry cough
  • Shortness of breath
  • Wheezing

Diagnosis

  • Blood tests
  • Bronchoalveolar lavage
  • Bronchoscopy
  • CT scan
  • Lung biopsy
  • Pulmonary function tests
  • X-ray

Treatment and procedures

  • Medication, such as steroids
  • Rehabilitation
In extreme cases, oxygen therapy or lung transplantation may be required.
Pneumonia

What is pneumonia?

Pneumonia is an infection of one or both of the lungs caused by bacteria, viruses, or a fungus. The air sacs fill with pus and other liquid.

Pneumonia can be categorized in two different ways:

  • Lobar pneumonia - Affects one or more sections of the lungs.
  • Bronchial pneumonia - Affects parts of both lungs.

The complications associated with pneumonia include:

  • Acute respiratory distress syndrome – A severe form of respiratory failure.
  • Lung abscesses - Pockets of pus that form inside or around the lung. They may need to be drained with surgery.
  • Respiratory failure - May require the use of a ventilator.
  • Sepsis - Blood infection that can cause organ failure.

Risk factors

The risks associated with having pneumonia are based on which type of pneumonia a patient has. There are more than 30 different types, but the main variations of pneumonia are:

  • Bacterial pneumonia- It is caused by bacteria, and the most common is Streptococcus pneumonia. It often occurs when the body is weakened by illness, malnutrition, older age, or depressed or impaired immunity.
  • Risk factors include:
    • Adults 65 or older
    • Alcohol consumption
    • Children under 2 years old
    • Respiratory disease
    • Smoking
    • Surgery
    • Viral infection
    • Weak immune system
  • Viral pneumonia- It is caused by a virus, including the flu. The virus responsible for COVID-19 can also cause viral pneumonia.
  • Mycoplasma pneumonia- It is caused by the bacteria Mycoplasma pneumonia. It usually causes mild, widespread pneumonia that affects all age groups.
  • Other types of pneumonia can be caused in a variety of ways, including from a fungus.

Symptoms

Bacterial pneumonia:

  • Blue lips and fingernails
  • Chest pain
  • Confusion
  • Cough
  • Fatigue
  • Fast pulse
  • Fever
  • Loss of hunger
  • Rapid breathing
  • Shaking or chills
  • Shortness of breath
  • Sweating

Viral pneumonia

  • Headache
  • Muscle pain
  • Shortness of breath
  • Weakness
  • Worsening cough

Mycoplasma pneumonia

Various symptoms, which might include a cough that propels produces mucus or sputum.

Diagnosis

  • Blood test
  • Bronchoscopy – Flexible tube is used to exam the bronchi of the lungs.
  • CT scan
  • Pleural fluid culture – A thin needle is inserted into the skin to extract fluid from the space between the lungs and the chest wall.
  • Pulse oximetry – A small machine measures the level of oxygen in the blood and is usually clipped to a finger.
  • Sputum culture
  • X-ray

Treatment and procedures

The treatment used depends on the type of pneumonia a patient has. Bacterial pneumonia is treated with antibiotics, as well as some cases of mycoplasma pneumonia. Viral pneumonia does not have any specific treatment, but it heals on its own.

Additional steps such as oxygen therapy, fluid intake, sleep, pain medication, and nutrition can be used to assist in recovery.

Prevention

The flu is a common cause of pneumonia, so getting a flu shot every year can help prevent both the flu and pneumonia.

There are also two pneumococcal vaccines, which can protect from a common form of bacterial pneumonia. Children younger than age 5 and adults ages 65 and older are encouraged to get a pneumococcal vaccine.

The pneumococcal vaccine is also recommended for those who are at greater risk for pneumococcal disease because of other health concerns.

Tuberculosis

What is tuberculosis?

Tuberculosis (TB) is a chronic bacterial disease that can infect various organs and parts of the body, including the lungs, kidneys, spine, and brain. It is an airborne disease that can be spread from person to people, such as through coughing or sneezing. It can also cause an infection after a period of time in a person who was infected in the past.

Tuberculosis can be fatal or cause severe complications if untreated.

Risk factors

  • Age
  • Excessive alcohol consumption
  • Living environment
  • People who live or work with others who have Tuberculosis, including hospital staff
  • People from countries where TB is prevalent
  • Poor or untreated health conditions
  • Smoking

There are also diseases and health conditions that also weaken the immune system and can cause a patient to be susceptible to obtaining tuberculosis:

  • Bronchiectasis or bronchitis
  • Chronic obstructive pulmonary disease and Emphysema
  • Cystic fibrosis
  • Human immunodeficiency virus (HIV)
  • Environmental lung diseases
  • Lung transplantation

Symptoms

  • Chest pain
  • Chills
  • Cough
  • Coughing blood
  • Fatigue
  • High fever
  • Lack of growth in children
  • Loss of appetite

Diagnosis

  • Blood test
  • Bronchoscopy
  • Lung biopsy
  • Skin test
  • Sputum culture
  • X-ray

Treatment and procedures

Some treatment may hospitalization and medication and, if not treated early, may require surgery.

Treatment includes:

  • Lifestyle changes
  • Avoid hot tubs
  • Filtered water for drinking
  • Fluid intake
  • Quit smoking
  • Reduce exposure to unfiltered water toxins from humidifiers
  • Rest

Medication

  • Aminoglycoside
  • Ethambutol
  • Isoniazid
  • Macrolide drugs, like azithromycin and clarithromycin
  • Pyrazinamide
  • Rifampin

Surgery

  • Chest tubes
  • Minimally-invasive incisions
  • Surgical resection, such as segmentectomy, lobectomy, and pneumonectomy
  • Thoracotomy – Incision to open the chest