Pulmonary – Patient Care and Treatment
Compassionate care for pulmonary disorders
We recognize that no two patients are alike—so our specialists treat no problem generically. We’ll take the time to listen to you and your referring physician, then develop a treatment and rehabilitation plan that best meets your needs. We focus on returning patients to active lifestyles and exploring alternatives to surgery when feasible.
Pulmonary Function Laboratory
The Pulmonary Function Laboratory meets both outpatient and inpatient diagnostic needs. Routine studies include:
- Flow volume loops
- Maximal voluntary ventilation
- Diffusion capacity and lung volumes by both plethysmography (with or without airway resistance) and nitrogen washout methods
- Arterial blood gases
- MIP (NIF) and MEP measurements (maximal inspiratory pressure or negative inspiratory force and maximal expiratory pressure)
Specialized studies include bronchoprovocation for the diagnosis of asthma utilizing exercise or a methacholine challenge and a complete airway challenge evaluation (CACE) study. Nocturnal oximetry studies are also performed for those with nocturnal hypoxemia related to chronic obstructive or restrictive pulmonary disease and congestive heart failure. Six-minute walk tests are also performed for desaturation or distance studies.
These services are accessible to both Penn State Health Milton S. Hershey Medical Center physicians as well as physicians who are not in the HMC system.
Diagnostic and Therapeutic Bronchoscopy
Since 2002, the Medical Center has expanded its bronchoscopy services and continues to do so with the advent of the new Cancer Center. Both diagnostic and therapeutic bronchoscopies are performed in the Bronch/Endo/Litho (BEL) suite in the main hospital five days per week.
The medical director of bronchoscopy, Dr. Jennifer Toth, supervises pulmonary fellows and performs procedures along with a dedicated team of technicians and nurses. Routine diagnostic procedures such as bronchoalveolar lavage, transbronchial biopsy, and microbiology and cytology brushings are performed safely and efficiently on a daily basis.
A particular strength of the service includes the advanced diagnostic technique of transbronchial needle aspiration (TBNA) of lymph nodes, which is a vital minimally invasive staging technique for lung malignancies as well as a valuable tool for diagnosing entities such as sarcoidosis, lymphoma, and atypical infection.
The bronchoscopy service places a special emphasis on the diagnosis, management, and palliation of lung cancer cases. Interventional procedures include:
- Argon plasma coagulation/electrocautery of endobronchial lesions
- Airway stenting
- Balloon bronchoplasty
- Autofluorescence bronchoscopy airway exam for early detection and management of premalignant lesions and carcinoma in situ (forthcoming)
The service is heavily involved with the Multidisciplinary Thoracic Oncology conference, held weekly, which coordinates the care of patients with other specialists, including cardiothoracic surgery, medical oncology, radiation oncology, and nuclear medicine.
Cystic Fibrosis Program
Dr. Robert L. Vender, director of the Adult Cystic Fibrosis Program, plans to develop and expand clinical care and resources for adult patients with cystic fibrosis in collaboration with Dr. Michael Pallone and Dr. Stuart Warren of the Department of Pediatrics.
Pulmonary Hypertension and Pulmonary Vascular Diseases Program
We offer world-class care for patients with pulmonary hypertension and pulmonary vascular diseases through a comprehensive, multidisciplinary program. The team includes dedicated pulmonologists, cardiologists, interventional radiologists, and specialty nurses.
- Prompt diagnostic evaluation by a pulmonologist and follow up by a cardiologist, if needed
- Diagnostic testing including right heart catheterization, acute vasoreactivity testing, stress echocardiography, and cardiopulmonary exercise testing
- Full range of conventional and new therapies for pulmonary arterial hypertension, including endothelin receptors antagonists, phosphodiesterase inhibitors, and intravenous and inhaled prostacyclin analogues
Who may benefit?
We help patients with:
- High pulmonary artery pressure on echocardiogram or heart catheterization with suspected pulmonary arterial hypertension (PAH)
- Idiopathic pulmonary arterial hypertension (iPAH)
- PAH associated with:
- Rheumatological disorders, such as SLE or scleroderma
- Adult congenital heart disease
- Advanced liver disease and portal hypertension
- Appetite suppressant use in past
- Pulmonary thromboembolic disease
- Sickle cell disease, HIV, sarcoidosis, pulmonary, veno-occlusive disease, and others
- Dyspnea not fully explained by pulmonary function testing or chest imaging, in the absence of suspected cardiac or neuromuscular diseases
- Complicated chronic thromboembolic disease
- Other pulmonary vascular diseases, such as symptomatic mediastinal fibrosis
Medical Intensive Care Unit and Intermediate Care Unit
The Medical Intensive Care Unit and Intermediate Care Unit continue its operation under the co-direction of pulmonary and critical care medicine and cardiology. This facility provides a multidisciplinary approach to therapy of the critically ill patient.
In addition to state-of-the-art monitoring and ventilators, a procedure room on the unit is equipped with fluoroscopy. The Intensive Care Unit is staffed full time by attendings and fellows from the Division of Pulmonary, Allergy and Critical Care Medicine and Cardiology and by housestaff from departments of medicine.
The pulmonary medicine division has a certified diagnostic sleep laboratory designated to evaluate and treat patients with sleep apnea, snoring, nighttime breathing symptoms, abnormal sleep behavior, narcolepsy, and other sleep disorders.
The pulmonary faculty with expertise in sleep medicine collaborates with the Sleep Diagnostic Laboratory and provides polysomnography interpretation. The patients are referred for the diagnosis of sleep apnea syndrome, nocturnal hypoxemia related to chronic obstructive or restrictive pulmonary disease, and congestive heart failure. They also assess the efficacy of various therapeutic interventions, such as nasal CPAP, oxygen, and upper airway surgery.