Dr. Elie Mansour, MD FCCP

Dear patient,

Smoking for many years can unfortunately lead to many respiratory ailments, including chronic bronchitis, COPD and emphysema among others. Many of these conditions share similar symptoms due to the damaging effects of the toxins found in processed tobacco on the structure of the lungs itself as well as the airways. Shortness of breath is a common symptom to all of those conditions, and with chronic bronchitis it is usually associated with a cough, chronic in nature and productive of clear or slightly discolored phlegm- what is commonly known as a smoker's cough. In addition to benefiting from an inhaler regimen that your pulmonologist would tailor to your needs, many patients with chronic bronchitis and COPD also benefit from a program known as pulmonary rehabilitation. This is a well structured program spread over 36 sessions, done at a facilities under the supervision of a respiratory therapist. These facilities are specialized and are not usually found at any regular physical therapy place, unless they specifically state it. It involves a combination of exercises aimed at improving upper body strength and general endurance, while your vitals and oxygen levels are being monitored. Medicare and other insurances usually cover it 100%. It is extremely important that you follow through on the program with no or minimal interruptions, otherwise you would lose all the benefits that you acquired prior to the interruption, and you would not be eligible to restart again from the beginning. Patients who benefit from it the most are those who experience difficulty breathing on exertion and those who have a limited endurance with activity. Patients who are either totally or partially oxygen-dependent also benefit from it significantly. I do suggest to all my patients that they continue their therapy with maintenance sessions at whatever facility they go to, usually about twice a week, even after you complete the 36-session program. Though that may imply a fairly affordable out-of-pocket expense cost, it will help preserve and maintain all the benefits that you would have acquired through the  program. 
Good luck in your decision, and I hope this information has been somewhat helpful to you.

Elie Mansour MD, FCCP

Dear father,

Allergies and asthma often go hand in hand. Both conditions are part of an inflammation process called atopy. Inflammation is the way the body's immune system reacts upon being exposed to a substance that it considers to be a threat. This substance may be a dangerous bacteria or virus, in which case the inflammation response is appropriate, to try and eliminate the offending agent. In other cases, the substance may be an inoffensive grain of pollen or a dust of grass which is attacked by the immune system, causing more or less severe allergy symptoms. Sometimes when those allergy symptoms occur in the lungs, the reaction is known as atopic asthma or allergic asthma, which is characterized by shortness of breath, wheezing, chest tightness and cough. Part of the treatment involves controlling the underlying allergic reaction itself, in addition to treating the asthma symptoms with inhalers or possibly nebulized medication or pills, depending on the severity of the condition.I hope this brief explanation will help you understand more what is happening with your daughter. My advice to you is to have her evaluated by a pulmonologist who should be able to handle both issues and prescribe the proper combination of medication if necessary.

Respectfully, 

Elie Mansour, MD, FCCP

Dear patient,

I'm responding to your inquiry about the diagnosis of pulmonary fibrosis. The use of this terminology is sometimes confusing. The term is often used by radiologists to describe some sort of non-specific scarring of the lungs. This scarring could be the result of an old injury to the lungs from pneumonia, or an exposure to harmful chemicals, or an inflammation from autoimmune illnesses. This scarring may be stable and not progressive in nature, in which case there would be no need for any treatment or intervention, just monitoring. However, there are situations where the pulmonary fibrosis could be due to a more serious condition called interstitial pneumonitis, which comes in different types. One of those types, also known as IPF or Idiopathic Pulmonary Fibrosis, is a progressive lung scarring illness which, IF NOT TREATED, could lead to respiratory failure and death within a few years of diagnosis. It is extremely important to determine whether you have that particular type of fibrosis because if you do, treatment should be started immediately to prevent the progression of the illness. The diagnosis is made by performing an imaging study called HRCT, or high-resolution CT scan, of the chest. In most cases, if done at the right facility and read by an experienced radiologist, HRCT can establish the diagnosis of the type of pulmonary fibrosis that you have without the need for any further intervention like a lung biopsy or any other invasive procedure. As I said before, if the diagnosis of IPF is made, it is imperative that you start treatment ASAP to prevent the progression of the illness EVEN IF YOU CURRENTLY FEEL WELL. The treatment is for life and your doctor currently has the choice between 2 different products that are on the market. Those products have been approved in 2014 and their approval has made a tremendous impact on the treatment of this otherwise terminal condition. Thanks to this treatment, patients with this condition are now able to live a normal life and to prevent the progression of the lung scarring process. Make sure you get referred by your primary to a pulmonologist who is familiar with this condition and its treatment, and to get your HRCT done at the proper facility.
I hope this information was helpful to you and I wish you all the luck.

Sincerely,

Elie Mansour, MD, FCCP