PCCMA Hires Four New Medical Staff

Independent practice adds experienced physician and supporting medical staff to growing practice

Pulmonary and Critical Care Medicine Associates

LEMOYNE, Pa. — Pulmonary & Critical Care Medicine Associates (PCCMA), an independent medical practice based in Lemoyne, today announced four new hires to meet increasing demand for its pulmonary, critical care and sleep lab services.

Dr. Charles Inner, M.D. joined PCCMA as a physician and Cara Centrella joined as a physician assistant. Kellie Shapiro and Sherry Ayler joined as nurse practitioners. The new team members increase the practice’s total number of employees to 50 with expectations of adding additional staff throughout 2019.

“We are very excited to expand our medical team and continue to provide our patients with expert and compassionate care,” said Jason Alexander, Executive Director of PCCMA. “Charles, Cara, Kellie and Sherry add a wealth of diverse experience to our clinical team. We are proud of our continued growth as Central Pennsylvania’s largest independent pulmonary practice group.”

Dr. Inners will focus on seeing pulmonary patients at PCCMA’s Lemoyne office. He has served as president of the medical staff at LifeCare Hospitals of Mechanicsburg since 2013. Dr. Inners graduated first in his class at John Hopkins University School of Medicine.

Centrella will work with the practice’s outpatient pulmonary and sleep patients. She previously worked as a family medicine physician assistant at UPMC Pinnacle Health Medical Group. She received her master of science degree in physician assistant studies from Marywood University.

Ayler will serve as a nurse practitioner supporting outpatient and sleep patients. She has worked in nursing for more than 23 years. Ayler’s previous experience includes 16 years at Penn State Hershey Medical Center. She received her master of science degree in nursing from Millersville University.

Shapiro will support pulmonary and sleep lab patients and will spend time in community hospitals and clinics. Shapiro previously worked as an adjunct and assistant professor at Harrisburg Area Community College teaching classes for licensed practical nursing (LPN). She received her bachelor of science degree in nursing from Marywood University and is expected to receive her master of science in nursing from Purdue Global in May.

In addition to its Lemoyne office, PCCMA also has offices in Carlisle and York and is UPMC Pinnacle’s select provider of pulmonary and critical care at UPMC Pinnacle hospitals in Central Pennsylvania.

What Happens to Your Body When You Stop Smoking?

What Happens to Your Body When You Stop Smoking?

It’s a well-established fact that smoking increases a person’s risk of lung disease, respiratory problems, cancer, stroke and heart attack. Many smokers know the negative health effects, but have trouble quitting due to the addictive nature of nicotine. Read on to find out how long it takes the body to recover from smoking and tips to get you on the path to healthier lungs.

Smoking and Your Lungs

Smoking causes irreversible scarring of the lungs that can lead to permanent damage. Quitting won’t repair that damage, but it can prevent further scarring.

Cilia are hair-like projections that keep airways clear of dirt and mucus, helping the breathing process. Cigarette smoke paralyzes and damages cilia in the lungs. They start to regain normal function soon after a person quits smoking. Therefore, it’s normal to cough more than usual at first. Coughing is a sign that cilia in the lungs are beginning to clean the airways again, which also improves the immune system.

Within just two weeks, people who quit smoking report improved lung function. Within one to nine months of quitting, coughing and shortness of breath will decrease. Additionally, the cessation of smoking prevents emphysema, a chronic disease caused by damaged air sacs in the lungs. (Learn more about a new FDA approved treatment for emphysema.)

Tips for Quitting

Many people testify that the hardest part about quitting is making the firm decision to quit. Every person is different, but here are a few tips to try:

  • Talk with your doctor
  • Set a firm date for your last cigarette
  • Start a new physical activity you enjoy
  • Save the money you would have spent on cigarettes and use it to buy a reward for yourself
  • Use medicine to help cope with nicotine withdrawal
  • Follow these tips from the Center for Disease Control

Most importantly, remember that smokeless tobacco, cigars and vaping are not safer alternatives to cigarettes. (Does Vaping Cause Cancer?)

It’s Never Too Late to Quit Smoking

Quitting can improve your health and the health of those around you. Exposure to secondhand smoke is dangerous to friends, family and even pets. This is especially true for people with existing heart or lung disease, as well as children and infants.

Even older adults can benefit from quitting, regardless of age or how long they have been a smoker. In addition to improved breathing, quitting will help the body lower heart rate and blood pressure, improve taste and smell, and lower the risk of heart attack and stroke.

5 Things to Know Before Your Sleep Study

5 Things to Know Before Your Sleep Study

The average adult requires between seven and nine hours of sleep each night for their body to function optimally throughout the day. Unfortunately, up to 70 million adults in the U.S. have a sleep disorder that prevents them from getting consistently restful sleep.

To diagnose and treat sleep disorders, medical professionals often recommend that patients undergo a sleep study.

About Sleep Studies

A sleep study, also known as a polysomnography, is an overnight exam that provides insights into your brain and bodily functions while you sleep.

The test is used to diagnose sleep apnea, narcolepsy, restless leg syndrome, circadian rhythm disorders and other sleep-related problems.

What to Know Before the Sleep Study

  1. Your comfort is a priority

    Our sleep studies take place at a medical facility, but the room has the look and comfort of a hotel room. You’re encouraged to bring personal items, such as pajamas and a toothbrush.

    The sleep study itself is painless and noninvasive. Tiny sensors will be placed on your head and body to monitor various bodily and brain activity, but the sensors will not restrict your movement during sleep. The sensors may feel awkward at first, but we do our best to make you as comfortable as possible.

  2. Come prepared

    A sleep study won’t drastically change your daily routine, but there are a few steps to take before arriving for the study.

    You should wash and dry your hair prior to the study, but avoid putting any product in your hair. Any oils or sprays can make it difficult for the sensors to adhere to your scalp. You should also try to avoid naps the day of the study and stay away from caffeinated beverages later in the day.

  3. Communication is key

    You should enter your sleep study with a basic understanding of the process, so don’t be afraid to ask questions before and during the study.

    You should also be fully honest with staff about any prescription and recreational drugs you take, as well as any special needs you have (i.e. physical limitations, trouble getting out of bed, nocturnal enuresis, etc.).

  4. Help is always close

    Although you’ll have privacy during the sleep study, staff is always nearby in case of emergency.

  5. Results are not instantaneous

    It can take up to two weeks for sleep study results to be processed. Once your doctor evaluates all the data from the study, they will schedule a follow-up visit to discuss your results and formulate a treatment plan, if necessary.

If you have specific questions about sleep studies, call the PCCMA office at (717) 234-2561. To learn more about sleep apnea, join us at our upcoming community discussion April 27!

New Inhalation System Treats Premature Babies with Lung Disease

New Inhalation System Treats Premature Babies with Lung Disease

Fifteen million preterm babies are born each year worldwide. Oftentimes, the lungs of infants born prematurely haven’t had time to fully develop.

Premature newborns often need artificial ventilation to supplement existing lung function. While necessary, this treatment can sometimes cause bronchopulmonary dysplasia, a chronic lung disease.

Because premature infants have suppressed immune systems, they also have an increased risk of infection. Lung infections are best treated with inhaled drugs, generally allowing for a lower treatment dose than other delivery options.

Therein lies the problem; inhalation systems that work well for children and adults are not adapted to efficiently treat premature babies and infants. Infants take between 40 to 60 breaths per minute, which is rapid compared to children and adults. Their tiny lungs also hold a smaller volume of air.

Researchers at the Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM) are developing a system that shows promise for alleviating the current barriers of treating infants who require inhaled drug treatment.

The Gentle Approach

By combining a nasal prong with a miniature aerosol valve, researchers have found an effective treatment method that is gentler on the newborns’ small lungs.

The aerosol valve is applied directly to the premature infant’s nose, and is controlled by a sensor film. The film detects movement in the upper abdomen. Just as the baby is taking a breath, aerosol is released.

They call it a “breath-triggered inhalation system” because the treatment is delivered in a rapid, targeted manner. The aerosol release timing is controlled by an intelligent algorithm that allows for accuracy of about 20 milliseconds.

In tests, this treatment showed a 60 percent increase in efficiency when compared to conventional inhalation technology.

The inhalation system is currently not production-ready, but it should be fully developed within three to five years.

Further Research

In addition to this initiative, the same research team is researching applications for administering dry-powder formulas via inhalation. This method would be used to treat preterm babies with infant respiratory distress syndrome, which can occur in underdeveloped lungs.

Sleep Disorders May Affect Women Sooner than Men

Sleep Disorders May Affect Women Sooner than Men

It’s a misconception that snoring is a common problem that doesn’t require medical attention. Research shows that anyone who snores should see a doctor to rule out a sleep disorder, such as sleep apnea (which studies now show may increase to cognitive decline). However, snoring may not be the only warning sign a person should look out for.

Sleep disorders are diagnosed more frequently in men than women. They are specifically diagnosed most often in men over the age of 40. Although symptoms present themselves at a similar age among both genders, the disorder takes longer to diagnose in women. This is because women present different symptoms.

According to research from the American Academy of Sleep Medicine, male snoring is more likely than female snoring to be the cause of couples sleeping in different rooms. A disruption like this is often the driving force behind a doctor’s appointment.

While women may snore, sleep apnea tends to present itself in other ways. Women are more likely to have symptoms of depression, daytime sleepiness, insomnia, difficulty concentrating and memory problems. While disruptive to daily life, these symptoms are easily attributed to other underlying causes, leading to delayed diagnosis.

Case Study

In one study, researchers analyzed data from 4,800 participants. One group consisted of people diagnosed with obstructive sleep apnea, the second group self-reported snoring, and the third was a control group with no sleep-related disorders or symptoms.

The study showed that the hearts of people with sleep apnea and snoring had enlarged walls in the left ventricle, which causes the heart to work harder.

Looking at the group of self-reported snorers, women had a more significant enlargement than men when compared to their counterparts in the control group.

The Importance of Early Diagnosis

When left untreated, obstructive sleep apnea can lead to high blood pressure, cardiovascular problems and stroke. Sleep apnea is also associated with type II diabetes and depression.

If sleep apnea and other disorders are diagnosed early, the resulting treatments (often a CPAP machine or nighttime dental device) can improve nighttime sleep and breathing. This leads to a decrease in severe side effects, such as heart problems.

It is especially important for women to recognize and acknowledge symptoms that could be caused by sleep disorders.

FDA Approves Valve for the Treatment of Emphysema

FDA Approves Valve for the Treatment of Emphysema

Emphysema is a progressive, life-threatening form of chronic obstructive pulmonary disease (COPD) that affects an estimated 3.5 million Americans.

In patients with emphysema, walls between the lungs’ air sacs are damaged, inhibiting oxygen flow. This can cause shortness of breath that makes everyday tasks very difficult.

New Treatment Option for Emphysema

Until recently, treatment for emphysema was limited to invasive surgical options, such as lung transplantation or lung volume reduction surgery.

In June of 2018, the Food and Drug Administration approved a minimally-invasive devise that can be used to treat patients with severe emphysema. The Zephyr® Endobronchial Valve System proved to be effective and less risky than existing treatments.

In fact, the FDA granted Breakthrough Device designation to the valve, meaning the company received intensive guidance to expedite development and review of the valves. The FDA chose to expedite the process in the best interest of emphysema patients who could benefit from the new technology.

The device was analyzed through a multi-center study of 190 patients with severe emphysema. Nearly half the study’s patients treated with Zephyr Valves experienced a 15% improvement in lung function. They reported higher energy levels, an easier time breathing and an improved quality of life.

The valves are about the same size as a pencil eraser. They are strategically placed in a patient’s lungs with the use of a flexible bronchoscope. Their placement protects damaged parts of the lung. The devices then open during exhalation and close during inhalation, helping the lungs to regain normal function lost when air sacs are damaged.

Limitations of the Valve

Although the valve shows great promise, there are limitations to who can receive this breakthrough treatment. A patient won’t qualify if they:

  • Have an active lung infection
  • Are allergic to nickel, titanium, silicone or nitinol
  • Are an active smoker
  • Cannot tolerate bronchoscopic procedures

It may also not be an option for patients with a history of heart disease or major lung procedures.

Though the procedure is minimally invasive, there are still potential risks. A person should speak with their health care provider to determine if the Zephyr Valve is a safe and viable treatment option for them.

What is a PFT (Pulmonary Function Test)?

What is a PFT (Pulmonary Function Test)?

A pulmonary function test (PFT) measures how well a pair of lungs work. These simple, low-risk tests can assist in diagnosis and treatment of lung disorders.

A physician may order a PFT to gain insight into a lung-related problem. They are common when diagnosing and monitoring chronic lung conditions, allergies, restrictive airway problems and respiratory infections. The test can also be used for patients with diseases like sarcoidosis and scleroderma.

Types of Pulmonary Function Tests


The most basic type of lung function test is spirometry, most often used to diagnose diseases like COPD and asthma. It measures rate of air flow and the volume of air the lungs can hold.

This test requires that a person breathes into a tube connected to a computer. Some breaths will be normal, but the test also requires breathing at maximal effort.

Lung Volume Test

A lung volume test is another way to measure how much air lungs can hold. It is more precise than spirometry because in addition to measuring the amount of air in the lungs, it also it measures the air remaining at the end of a normal breath.

This test is very similar to spirometry, but the person will perform the test in a small room with clear walls.

Lung Diffusion Capacity

A lung diffusion capacity test only requires normal breathing, so the risk of lightheadedness is very low. During the test, a person breathes in and out of a tube. The test itself only takes a few minutes, but the doctor may also require a blood sample to measure hemoglobin levels.

Arterial Blood Gas Test

Your lungs are responsible for taking oxygen from the air you breathe and transporting it throughout the body. If your healthcare professional is concerned about the levels of oxygen and carbon dioxide in your blood, they may recommend an arterial blood gas test. For this test, blood is taken from an artery in the wrist, then analyzed.

Fractional Exhaled Nitric Oxide Test (FeNO)

Nitric oxide is a marker for inflammation in the lungs. Fractional exhaled nitric oxide tests measure the amount of nitric oxide exhaled. A person simply exhales into a tube that is connected to a portable device.

Risks of PFTs

Pulmonary function testing has very little risk. Aside from tests that are accompanied by blood work, they are completely non-invasive. The most common issues include dizziness during the test, coughing, shortness of breath, or an asthma attack triggered by deep breathing.

If you have specific questions about any of these PFTs, don’t hesitate to ask your provider.

How Does Winter Affect Asthma?

How Does Winter Affect Asthma?

For those living with asthma, it’s not uncommon for symptoms to worsen in the winter.

The cold, dry winter air serves as an irritant for lung diseases like asthma, COPD and bronchitis. People spend more time indoors during the cool winter months, leaving them more exposed to asthma triggers such as mold, pet dander and dust mites.

Signs of lung irritation include:

  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest tightness

The first step for an asthmatic is identifying what situations trigger these adverse symptoms. From there, you can formulate a plan to protect your lungs all season long.

Reducing Risk

To avoid serious medical emergencies, take daily steps to manage their asthma in the winter.

Carry a Scarf. If a sudden change in temperature triggers asthma symptoms, consider using a scarf to cover your nose and mouth on colder days. When exiting a warm building and stepping into the cooler winter air, the scarf will act as a barrier, providing additional warmth and moisture for air that enters the lungs.

Use an Inhaler as Prescribed. For patients who use an inhaler to manage symptoms, it is important to stay on schedule. Continue to use a control inhaler (as prescribed) and carry a rescue inhaler at all times. If an asthmatic finds that they are using a rescue inhaler excessively, they should consult with their doctor.

Get a Flu Shot. When asthma patients contract the flu, it can make breathing even more difficult (COPD patients are also more likely to experience complications with the flu). Immunization is the best way to avoid contracting the virus. To minimize the risk of catching a common cold, wash your hands regularly and avoid contact with anyone who is ill.

Consider Air Quality. People who spend more time indoors during the cold winter months are exposed to more indoor air pollutants. An indoor air purifier can help remove some irritants from the air at home.

Support System. In case of emergency, those with severe asthma should keep friends and family informed of their whereabouts.

By learning their asthma triggers and preparing accordingly, you have the best chance of staying safe and healthy throughout the winter months.

PCCMA Invites Public to Learn About Common Sleep Problems at Community Event Feb. 9

80 million adults have sleep apnea; only 1 in 5 are diagnosed
Experts to lead discussion on sleep apnea, treatment options

PCCMA Invites Public to Learn About Common Sleep Problems at Community Event Feb. 9

Pulmonary & Critical Care Medicine Associates is holding a community event focusing on sleep apnea, a common condition that affects a person’s breathing during sleep. The event, free and open to the public, will be held Saturday, Feb. 9, from 10 to 11 a.m. at the PCCMA Sleep Center at 50 N. 12th St. in Lemoyne.

More than 18 million adults in the United States have sleep apnea, but only about 20 percent have been diagnosed. A person with sleep apnea has times during sleep during which air cannot flow normally into the lungs. These pauses in airflow can occur off and on during sleep, and cause a person to wake up from a sound sleep. If sleep apnea is not treated, serious health problems may develop including type 2 diabetes, high blood pressure, heart disease and depression.

Attendees will learn about sleep apnea symptoms, diagnosis and treatment options. Patients previously diagnosed with sleep apnea are also encouraged to attend to ask questions about treatment options and hear from other patients.

PCCMA Sleep Center Manager Salvatore Santelli, RPSGT, CSE and Respiratory Therapist Trevor Burns, BS, RRT will lead the discussion.

Space is limited. To register, contact Trevor at (717) 629–7168.

Lemoyne: 50 N. 12th Street, Lemoyne, PA 17043
Carlisle: 220 Wilson Street, Suite 104, Carlisle, PA 17013
York: 1750 5th Ave, Suite 300, York, PA 17403

Phone: (717) 234-2561

For medical emergencies, call 911.

© 2019 Pulmonary & Critical Care Medicine Associates