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About Us
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What We Treat

Conditions & Treatments

Respiratory Care + Sleep Medicine (RCSM) delivers best-in-class diagnosis and treatment for a wide spectrum of respiratory and sleep conditions, disorders and diseases, including:

Respiratory Care Medicine

Asthma

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath and coughing. During an asthma attack, the sides of the airways of the lungs swell and the airways shrink, meaning less air gets in and out of the lungs. Asthma affects people of all ages and can start at any age, even late adulthood. Asthma is broken down into many different subtypes, including allergic asthma, hypereosinophilic asthma and hyper IGE asthma. We evaluate for all subtypes of asthma to determine the best treatment plan for your personal form of asthma.

Bronchitis

Bronchitis is a condition in which the bronchial tubes – the tubes that carry air to your lungs – become inflamed. Bronchitis can cause coughing that brings up mucus, which can frequently be discolored. It can also cause wheezing, chest pain, a low fever and shortness of breath. Acute (short-term) bronchitis can come from cold or flu viruses or other lung irritants. Chronic bronchitis is an ongoing, serious condition in which the lining of the bronchial tubes is constantly irritated and inflamed.

Pulmonary Fibrosis

Pulmonary fibrosis is the description that pulmonologists and radiologists use to describe a scarring process in the lungs. It has multiple possible causes, including previous infections, injuries or underlying inflammatory processes. It can either be stable or progressive, with the progressive form the most concerning. Usually affecting middle-aged and older adults, pulmonary fibrosis is a serious disease in which tissue deep in the lungs becomes thick and stiff, or scarred, over time. As the lung tissue thickens, the lungs can’t properly move oxygen into the bloodstream. The main symptom is shortness of breath, at first during activity, but over time even at rest. Another symptom is a dry, hacking cough that doesn’t get better, with repeated bouts of uncontrolled coughing.

Cystic Fibrosis (CF)

Cystic fibrosis (CF) is an inherited disease which causes severe problems in multiple organs, including the lungs, pancreas and gastrointestinal tract. In the lungs, CF typically causes a thick mucus build-up that causes airway obstruction. This leads to recurrent infections and distortions of the airways. Children and adults with cystic fibrosis usually form cysts in their lungs that are the leftovers of previous blockages and infections. Overtime these become larger and more distributed through the lungs, causing a progressive decline in lung function. People with cystic fibrosis need a very well-thought-out and specific treatment plan, which includes management of their particular infectious processes. This will frequently lead to antibiotic tune-ups and interventions from the pulmonologist. Because it affects multiple organs, we typically treat our cystic fibrosis patients in conjunction with other specialists, taking a multi-organ approach.

Lung Cancer

Cancer is a disease in which cells in the body grow out of control. When cancer starts in the lungs, it’s called lung cancer and it may spread to lymph nodes or other organs in the body. There are five specific types of lung cancer that all have different prognosis and treatment plans. Lung cancer symptoms may include coughing that gets worse or doesn’t go away, chest pain, shortness of breath and wheezing.

Lung cancer is the second most common cancer among both men and women in the United States, with cigarette smoking being the number one risk factor. We not only diagnose lung cancer, but we also participate in lung cancer screening programs to help with detection of lung cancer prior to its symptoms. These programs have shown to improve outcomes significantly. For those patients who do have a cancer diagnosis, we work closely with our oncology and radiation oncology colleagues to come up with an aggressive treatment program.

Lung Nodules

Lung (or pulmonary) nodules are abnormal spots found through imaging, such as CAT scans or chest X-rays. They are easy to find but sometimes hard to diagnose. Almost all lung nodules are discovered by accident, usually through imaging performed for other reasons. Most nodules are benign and not cancerous and are caused by previous infections or old surgery scars. Still, nodules need to be examined and watched closely because of the possibility they might be a small cancer. We work together with the patient to follow these nodules until we can ensure that there is no reasonable chance for cancer growth.

Pulmonary Hypertension

Pulmonary hypertension is a less common disorder that occurs when the pressure in the blood vessels leading from the heart to the lungs is too high. (These pressures cannot be measured by traditional blood pressures cuffs.) When the pressure gets too high, it results in less oxygen in the blood. Early symptoms include difficulty breathing and fatigue. Later, more severe symptoms are dizziness, chest pain and heart palpitations. There are different causes for pulmonary hypertension, and finding the cause is as important as the treatment.

Shortness of Breath

Shortness of breath is the sensation of not having enough breath or air to satisfy your body. It can come from many possible different sources, which can include exercise intolerance, anxiety, heart disease, lung disease or even muscle weakness. Evaluating and finding the cause of abnormal shortness of breath is very important in patients who have persistent or worsening symptoms. We will do a complete work up to evaluate the cause for your shortness of breath.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is an umbrella term that refers to a group of diseases that cause airflow blockage and breathing-related problems. The main cause of COPD is long-term exposure to substances that damage the lungs, such as cigarette smoke, air pollution, chemical fumes or even dust. At first, COPD may cause no, or only mild, symptoms. As the disease gets worse, symptoms usually become more severe, including frequent coughing or wheezing, excess phlegm or mucus, shortness of breath and trouble taking a deep breath. Diagnosing COPD is important, so that a treatment plan can help prevent exacerbations that could lead to disease progression.

Emphysema

Emphysema is a type of COPD involving damage to the air sacs (alveoli) in the lungs. When breathing, each air sac fills up with air and then deflates, like a small balloon. With emphysema, the walls between many of the air sacs are damaged or destroyed and do not function properly. As a result, the body does not get enough oxygen. Emphysema symptoms include a chronic cough and trouble breathing. The most common cause is cigarette smoking.

Cough

Cough is one of the top reasons for doctor visits in the United States. Cough can have many different causes, including post nasal drip syndrome, asthma, COPD, seasonal allergies, reactive airway disease, and even gastrointestinal diseases such as reflux. Interestingly, cough is frequently caused by multiple different triggers all occurring at once.

Sleep Medicine

Sleep Apnea

Sleep apnea comes in two general categories – obstructive sleep apnea and central sleep apnea. These two types can frequently overlap, with patients often having elements of both.

Obstructive sleep apnea (OSA) is typically characterized by chronic daytime fatigue, difficulty concentrating, frequent awakenings at night (including multiple trips to the bathroom), and the sensation of inadequate sleep. With OSA, breathing is briefly and repeatedly interrupted during sleep. “Apnea” refers to a pause in breathing that lasts 10 or more seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat or the upper airway fail to keep the airway open. This results in closure or obstruction of the airway despite multiple attempts to breathe. This interruption in airflow causes decrease in oxygen saturations and subsequent awakenings. The brain triggers the patient to get more oxygen by taking the patient out of deep sleep and waking them briefly to get a good, deep breath. Obstructive sleep apnea can be associated with diseases such as coronary artery disease; cardiac arrhythmias such as atrial fibrillation; stroke; and high blood pressure.

Central sleep apnea is caused by interruption in the brain’s drive to breathe. This can frequently be associated with diseases such as heart failure and stroke. Unrecognized central sleep apnea will lead to progressive heart and brain disease if left untreated.

Narcolepsy

Narcolepsy is a sleep disorder characterized by excessive sleepiness, “irresistible” tiredness, inability to move when awakening, and often loss of muscle control during highly emotional states such as fear or happiness. Narcolepsy stems from a neurological disorder that affects the brain’s ability to separate wakefulness from sleep. In-depth testing and genetics are frequently needed to make a diagnosis.

Insomnia

Insomnia is the inability to fall asleep or maintain sleep, even when given the chance to do so. It may also take the form of waking several hours early with the inability to fall back sleep. People with insomnia often feel dissatisfied with their sleep. Insomnia may cause fatigue, low energy, difficulty concentrating, excessive sleepiness and mood changes, with possible decreased performance at work or school. “Chronic psychophysiological insomnia” is a result of stress combined with the fear of being unable to sleep. The inability to sleep may also be caused by the side effects of medications, depression or anxiety. We rarely treat insomnia with sleeping medications (such as Ambien) because of their poor effect on the normal sleep cycle and addictive side effects.

Restless Legs Syndrome (RLS)

With restless legs syndrome (RLS), a person has an uncontrollable urge to move their legs due to an uncomfortable sensation. Patients have described it as a “creepy-crawly” sensation, tingling or burning, fatigue, cramping, or an intractable need to move. Moving makes the legs feel better, but not for long. These symptoms commonly occur in the late afternoon or evening and are often most severe at night when a person is trying to fall asleep and stay asleep – giving RLS its classification as a sleep disorder.

Periodic Limb Movement Disorder (PLMD)

Periodic limb movement disorder (PLMD) is involuntary leg and/or arm twitching or jerking movements during sleep. These movements sometimes last hours throughout the night and can frequently cause significant sleep interruption. This can contribute to insomnia and daytime fatigue. Restless legs syndrome (RLS) is differentiated from PLMD based upon when the symptoms occur. If symptoms occur before sleep, it is classified as RLS. If the patient is unaware of the symptoms but chronic movement is reported by their bed partner or detected in a sleep study, it is classified as PLMD.

Testing

Endoscopic Ultrasound (EUS)

An endoscope is a thin, tube-like instrument that has a light and a lens for viewing. It is inserted into the body. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal organs to make a picture (sonogram). This procedure is also called endosonography.

superDimension Bronchoscopy (Super D)

Bronchoscopy is a procedure in which a cylindrical fiberoptic scope with a viewing device is inserted into the airways. The superDimension system uses GPS-like technology to reach the deepest areas of the lungs. Using a 3-D map, physicians navigate through the lung to take biopsies, diagnosis disease and prepare for surgery.

Pulmonary (or Lung) function tests (PFTs)

PFTs measure how well the lungs work, including tests that measure lung size, volume and air flow. Other PFTs measure how well gases such as oxygen get in and out of the blood, such as pulse oximetry and arterial blood gas tests. Another PFT is fractional exhaled nitric oxide (FeNO), which is a marker for inflammation in the lungs.

Six-Minute Walk Test (SMWT)

The six-minute walk test is a simple measure of aerobic exercise capacity. During this test, a patient walks at a normal pace for six minutes. The results of this test may or may not lead to more sophisticated heart and lung function measurements, and can also be used to monitor a patient’s response to treatments already in place.

Spirometry

Spirometry is the most common type of pulmonary function test (PFT). Sitting upright, a clip is placed on the patient’s nose while inhaling and exhaling through a plastic mouthpiece connected to the spirometry machine. The machine measures how much, and how fast, the patient can breathe in and out.

Challenge Tests for Asthma

Challenge tests measure changes in lung function after inhaling a specific substance, most commonly methacholine. If a patient’s airways tighten and there is a decrease in lung function after breathing in methacholine, it’s an indicator of asthma.

Bronchoscopy

Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy.

Laser bronchoscopy

Bronchoscopy is a procedure in which a cylindrical fiberoptic scope with a viewing device is inserted into the airways. A laser beam directed through fiberoptic equipment helps guide the scope, and can be used to clear or cut out blockages.

Cardiopulmonary Exercise Testing (CPET)

Cardiopulmonary exercise testing is a non-invasive assessment of the performance of the heart and lungs during exercise and at rest. It measures of aerobic fitness or functional capacity and helps identify the cause of exercise issues.

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Respiratory Care + Sleep Medicine
1325 San Marco Blvd
Suite 300
Jacksonville, FL 32207
904-253-6910
904-253-6964 (fax)
info@rccsma.com