How Athletes Can Control Breathing Difficulties During Winter Workouts

Cold winter weather can make exercise more difficult. This is especially true for people with asthma. It’s estimated that 300 million people worldwide are living with asthma, according to the World Health Organization. At least 15 to 25 percent of athletes have asthma symptoms but haven’t been diagnosed with the disorder. However, it’s not only asthmatics who have increased difficulty with winter sports.

Exercising in the Winter

Typically, people breathe through their nose, which allows the air to be warmed and humidified before reaching the lungs. When exercising, people are more likely to breathe through their mouths due to the increased need for oxygen. This means cold, dry air reaches the lungs more quickly, which can cause irritation and make it more difficult to breathe. Breathing through the mouth also means that air isn’t filtered by cilia in the nose before reaching the lungs, so there may be a higher level of pollen or other pollutants.

Whether or not a person has a diagnosed case of exercise-induced asthma, their athletic performance may be hindered by exercise-induced bronchoconstriction (EIB). Within five to twenty minutes of exercising, people with EIB experience asthma symptoms like wheezing, chest tightness and shortness of breath.

Diagnosis and Treatment

It’s common for athletes to feel that they need to push through the pain but breathing problems can be serious. It’s best to consult a doctor as soon as symptoms present. Whether you exercise outdoors for pleasure or competition, it’s possible to keep symptoms under control so you can still enjoy your winter workouts. A medical professional can help formulate a plan to manage the symptoms. This may include the use of an inhaler.

For your own safety, here are a few steps to take during winter workouts if you’re prone to breathing difficulties:

  • Always have access to a phone in case of respiratory distress. A great alternative would be to exercise with a friend, so you have support in the event of an emergency.
  • Protect your airway by covering your nose and mouth with a scarf or mask during outdoor exercise. This increases the level of moisture in the air you breathe in.
  • Opt for indoor exercise if symptoms persist. It may also help to make outdoor exercises shorter and less vigorous.
  • Report any symptom changes to your doctor.


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Sleep Apnea Could Double the Risk of Drug-Resistant Hypertension in African-Americans

Sleep Apnea Could Double the Risk of Drug-Resistant Hypertension in African-Americans

Sleep Apnea Could Double the Risk of Drug-Resistant Hypertension in African-AmericansWhen a patient is diagnosed with hypertension, commonly referred to as high blood pressure, their treatment typically consists of self-care and medications to help lower their blood pressure. If blood pressure isn’t reduced to normal range after taking medication for the condition, doctors must figure out why.

For African-American adults, the answer may lie in an undiagnosed case of sleep apnea.

Findings from a 2018 Study

A study led by Harvard University researchers found that people with moderate or severe sleep apnea are twice as likely to have drug-resistant hypertension. The link between sleep apnea and high blood pressure isn’t new, but this research is different from studies in the past.

Instead of using self-reported data, this Harvard-led study detected the presence of sleep apnea via sleep studies. Of the 664 African-American participants in this study, more than a quarter had moderate or severe sleep apnea. A shocking 94 percent of the participants with sleep apnea were not previously diagnosed or treated for the disorder. The association between high blood pressure and sleep apnea was most prevalent among those with hard-to-treat hypertension.

All the participants were adults with hypertension who were also participants in the Jackson Heart Study, the largest investigation of cardiovascular disease in African Americans. Nearly half of the study’s participants had uncontrolled high blood pressure, and approximately 14 percent had high blood pressure that wouldn’t respond to medications.

Future Research

While this study has provided great insight, more research is needed to establish the cause-and-effect relationship between sleep apnea and drug-resistant hypertension. If untreated sleep apnea is the reason for drug-resistant hypertension, that means both diseases could potentially be improved with routine treatment for sleep apnea, such as the use of a CPAP machine.

For now, medical professionals can help their patients by looking at undiagnosed sleep apnea as a possible cause for drug-resistant hypertension.

Compared to white adults, black adults have a 90 percent higher chance of struggling with uncontrolled high blood pressure. There is no known cause for this, but researchers hope this study will inspire health care professionals to approach treatment and research differently in the future.


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Daily Tips to Improve Lung Function for Pulmonary Fibrosis Patients

Daily Tips to Improve Lung Function for Pulmonary Fibrosis PatientsPulmonary fibrosis is a lung disease that causes scar tissue deep inside a person’s lungs. Many cases are idiopathic, meaning there is no known cause. Because the disease is progressive, symptoms worsen overtime. There is currently no cure, so starting treatment early is the best way to ensure a better quality of life.

Medical treatments for pulmonary fibrosis sometimes include corticosteroids, oxygen, antifibrotic drugs, proton pump inhibitors and immune suppressants. Some patients also opt to try experimental treatments.

Tips to Improve Daily Lung Function

In addition to medication and doctor-recommended treatments, there are certain lifestyle changes that can help improve daily lung function for people living with pulmonary fibrosis.

  1. Monitor Oxygen Levels Regularly

An at-home pulse oximeter can be used to measure your oxygen levels throughout the day. Typically, the goal is for oxygen saturation to be above 90 percent. A lack of oxygen can cause mild problems, such as headaches and shortness of breath. In severe cases, heart and brain function may suffer.

  1. Pulmonary Rehabilitation

Pulmonary rehabilitation is often a staple in the treatment of pulmonary fibrosis. This treatment involves a variety of programs that aim to reduce shortness of breath while also improving daily life.

  1. Keep Vaccinations Up to Date

Pulmonary fibrosis patients should be vaccinated against diseases that could cause infection and further lung damage, such as the flu, pneumonia and whooping cough. Find out what vaccines are recommended for you on the Center for Disease Control’s Adult Vaccine Assessment Tool.

  1. Maintain a Healthy Weight

Being underweight or overweight can impact your ability to breathe. A registered dietitian can help determine your dietary needs so you can maintain a healthy weight.

  1. Quit Smoking

Smoking cigarettes causes lung damage. While the habit is not healthy for anyone, it is especially harmful for patients with pulmonary fibrosis. If you smoke, quitting now can prevent further damage. is a great free resource to get you on the path to quitting and keep you from picking the habit back up.

  1. Be Aware of Your Environment

People with pulmonary fibrosis may notice that certain environments trigger a decline in respiratory function. For example, dust, pet dander, the smell of chemicals at a hair salon, and gasoline fumes can irritate your lungs. Wearing a face mask can help in situations where triggers are unavoidable.

  1. Consider Joining a Support Group

It’s very important to have an emotional support system when you’re living with pulmonary fibrosis. Online communities and in-person support groups are great ways to connect with others who are struggling with your condition. The Pulmonary Fibrosis Foundation has a wonderful resource dedicated to finding local and online support groups.

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Can Caffeine Affect Your Circadian Rhythm?

Can Caffeine Affect Your Circadian Rhythm?Your circadian rhythm regulates your sleep cycle by telling your body when it’s time to sleep and when it’s time to be awake. This system can be disrupted by many external factors, including light exposure, food consumption, physical activity and certain medications. It’s well-known that caffeine can provide an energy boost, but is caffeine consumption another environmental factor that could affect your internal clock?

The Importance of a Regular Sleep-Wake Cycle

An irregular circadian rhythm can significantly effect your health and quality of life. Circadian rhythm disturbance can lead to an increased incidence of medical problems, such as:

  • Depression
  • Cancer
  • Cardiovascular disease
  • Diabetes

Caffeine’s Effect on Cellular Timekeeping

In past years, scientists have studied bread mold, green algae and fruit flies to discover that caffeine can alter the way certain cells keep time. This led one group of researchers to question whether caffeine has the same effect on human cells.

The study was conducted by a research team at the University of Colorado, Boulder. They conducted a 49-day double-blind, placebo-controlled sleep study. Participants were either exposed to caffeine, bright light or both 3 hours before bedtime. The caffeine dosage was equivalent to the amount in a double espresso.

Results of the study indicated that the caffeine dosage taken 3 hours before bedtime delayed circadian rhythm in the patients by approximately 40 minutes. Researchers also found that exposure to bright light before bedtime had a double effect of caffeine on participants.

There’s no denying that both caffeine and bright light have a significant impact on humans’ circadian rhythm.

Maintaining a Regular Circadian Rhythm

As this study suggests, it’s best to avoid caffeine at least 3 hours prior to regular bedtime. In addition to coffee, caffeine is also found in some teas, soda and chocolate.

When your internal clock is continually misaligned with your normal sleep schedule, it can put unnecessary stress on your body.

The effect of caffeine can vary from person to person based on a variety of factors, including genetics. Anyone who is sensitive to caffeine should be especially vigilant about the foods and beverages they consume later in the day.

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The Latest in Lung Transplant Research

The Latest in Lung Transplant ResearchSometimes patients suffer with lung diseases that don’t respond to treatment. In those instances, a lung transplant could be the only way to extend their lifespan and improve their quality of life. The lung transplant procedure is especially common in patients with end-stage lung disease.

Although it is a risky surgery, advancements in pre- and post-transplant procedures have improved patient outcomes. Here are two examples of recent findings that could lead to further improvements.

EVLP Can Expand the Donor Pool

Ex vivo lung perfusion (EVLP) is an innovative therapy that is applied to lungs outside of the body before transplantation. Within the past decade, the treatment has been used to improve the quality of organs so they can become suitable for transplant. It also allows more time to assess if the lungs have persistent dysfunction, which minimizes the chance of transplanting organs that can’t function properly.

A study published in 2018 revealed that an acellular normothermic EVLP technique could reduce cell-specific leukocyte gene expression over a 12-hour period. The technique also identified potential biomarkers that could improve the process for selecting lungs on EVLP. This process would select lungs that are suitable to be transplanted and predict the risk of primary graft dysfunction, a serious complication. Although further research is needed to validate these findings, the technique could identify marginal lungs that would be viable for transplant while simultaneously eliminating potential donor lungs that aren’t suitable.

Drug Combination May Minimize Chronic Rejection

Patients are at the highest risk for life-threatening complications within the first year of undergoing a lung transplant. High risk patients are required to take medications for the rest of their life to suppress the immune system and help prevent the body from rejecting the new lungs. Even with standard precautions and medical treatment, the median survival rate after lung transplant is less than six years. The most common causes of death are chronic rejection, infection and cancer.

In August 2019, researchers at the University of Maryland School of Medicine conducted a study that analyzed a database of over 9,000 lung transplants. Their research led to the identification of a drug combination that appears to significantly extend patient survival. The combination of tacrolimus, an immunosuppressant, and sirolimus, a cell cycle inhibitor, was associated with a better median survival than the current standard treatment.

While every patient’s treatment and recovery are unique, the findings of this study could make a difference in outcome for lung transplant patients in the future.


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Cases of Black Lung Disease Increasing Nationwide

Black lung disease is a respiratory disorder caused by breathing coal mine dust. The disease is also called coal workers’ pneumoconiosis (CWP). The prevalence of black lung disease has increased since 2012, according to the Center of Disease Control and Prevention (CDC). Current statistics report one in ten coal miners who worked in coal mines for 25 years or more have been diagnosed with black lung.Cases of Black Lung Disease Increasing Nationwide

Black Lung Disease: Causes and History

In 1969, Congress passed the Federal Coal Mine Health and Safety Act, making the elimination of black lung a national goal. The National Institute for Occupational Safety and Health has been tracking black lung disease in miners since the 1970s through their Coal Workers Health Surveillance Program. The program collects data and offers periodic chest x-rays to detect the disease early.

In the late 1990s, black lung disease dropped to the lowest level on record. However, since 2000, the disease has been increasing throughout the nation, especially in the Appalachian area. Coal miners in the Appalachian region are more likely to be affected than workers elsewhere in the U.S. Currently, one in five workers from central Appalachia have been diagnosed with the disease.

Simple vs Complicated Coal Workers’ Pneumoconiosis

Coal miners are susceptible to either a mild or severe case of CWP.

  • Complicated CWP, also known as Progressive Massive Fibrosis (PMF), is diagnosed when a patient’s lungs are severely scarred due to inhaling large amount of coal dust for a longer period of time.
  • Simple CWP is the milder diagnosis. This means the lungs have less severe spots or scar tissues from coal dust particles.

Both types of the disease present similar symptoms. They include coughing, shortness of breath and chest tightness. It often takes decades for the disease to develop, so many people don’t have symptoms until after they retire.

CWP Diagnosis and Treatment

Most CWP patients are over the age of 50 when they are diagnosed. During diagnosis, a doctor will take a detailed history to assess the patient’s exposure to coal dust. They will also order a chest x-ray or a CT scan. The patient may be asked to complete a pulmonary function test to show how well the lungs are working.

Black lung treatments can ease symptoms, but there is no cure for the disease. Since breathing coal mine dust is the only cause, the disease is highly preventable through dust control methods and proper protection to reduce exposure.

Early detection is also key to managing the disease. Current and retired coal miners should monitor their health regularly and consult their doctor if they notice respiratory symptoms.

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Obesity Strongly Linked to COPD in Non-Smokers

An estimated 15 million Americans live with chronic obstructive pulmonary disease (COPD), and it is the third leading cause of death in the United States. The most common cause of COPD is cigarette smoking; however, 23 percent of COPD patients have never smoked. New research indicates that obesity may be one contributing factor to those idiopathic cases of COPD.Obesity Strongly Linked to COPD in Non-Smokers

A study, published in the Journal of Obesity, was led by researchers at the University of Toronto to research the relationship between COPD and obesity in nonsmokers. The study included 76,004 women and 37,618 men aged 50 and older who had never smoked. They were categorized as being normal weight, overweight or with one of three classes of obesity.

Researchers discovered a higher prevalence of COPD in participants with higher BMIs. For example, women with class I or II obesity were twice as likely to have COPD than women of normal weight. This was still the case after statistically adjusting the results for factors like age, education and income, all of which have potential to cause COPD.

Explaining the Complex Relationship

There are three possible explanations for the link between obesity and COPD:

  • Obesity impairs diaphragm movement and compresses walls of the chest
  • Inflammation associated with obesity causes or worsens COPD
  • COPD predisposes patients to obesity because the symptoms result in decreased mobility

Although further research is needed to provide more insight into the correlation between obesity and COPD, the study was an important step in analyzing the cause of COPD in patients who have never smoked.

This study provided further evidence of obesity and COPD’s complex relationship. Previous research indicated that obesity has a protective effect on late-stage COPD. Patients who are underweight have a higher risk of dying from COPD than someone who is obese or average weight. However, both diseases can lead to further complications and worsened overall health.

Prevention and Treatment

Exercise is encouraged for COPD patients, especially those who are overweight or obese. For safety, it’s best to start with an exercise regimen guided by a medical professional.

It’s also important for healthcare professionals to routinely screen obese patients for COPD, even when they have no history of smoking.


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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.

Patient Freedom of Choice Notification


Pulmonary & Critical Care Medicine Associates (PCCMA) Physicians will no longer be providing pulmonary and intensivist care medical services at Geisinger Holy Spirit Hospital, effective May 1, 2019.

PCCMA physicians will continue to provide pulmonary and critical care medical services at all UPMC Pinnacle facilities, including Harrisburg Hospital, West Shore Hospital, UPMC Pinnacle Carlisle Hospital, and Community General Osteopathic Hospital.

Every patient has the right under federal and state law to be treated by the physician or specialist they choose. You can exercise your right to patient freedom of choice by advising your primary care physician or specialist that you would like to be treated by our PCCMA physicians.

If you are a patient with questions, please call our office at 717–234–2561. We encourage you to exercise your legal rights to receive treatment from the physician of your choice.

Lemoyne: 50 N. 12th Street, Lemoyne, PA 17043
Carlisle: 220 Wilson Street, Suite 104, Carlisle, PA 17013

Phone: (717) 234-2561

For medical emergencies, call 911.

© 2019 Pulmonary & Critical Care Medicine Associates