Asthma is a common disease involving the airways causing symptoms of wheezing, cough and shortness of breath. Over 18 million adults and 7 million children suffer from asthma.

Triggers of asthma attacks include tobacco smoke, dust mites, pets, outdoor pollution and other allergens.

Accurate diagnosis is important to guide medical therapy. Asthma can often be controlled with correct use of medications. Poorly controlled or undiagnosed asthma can lead to severe symptoms, hospitalizations and even death.

Drs. Fields and deKeratry are the first physicians in the Southwest to perform a new procedure for patients with severe asthma, bronchial thermoplasty.

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Bronchiectasis is permanent destruction and widening of the large airways from chronic inflammation. Symptoms often develop gradually, and may occur months or years after the event that causes the bronchiectasis. They include bluish skin color, halitosis (bad breath), chronic cough with foul-smelling sputum, coughing up blood, fatigue, shortness of breath, weight loss or wheezing.

Bronchiectasis usually is the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Once damaged, the airways slowly lose their ability to clear out mucus. When mucus can't be cleared, it builds up and creates an environment in which bacteria can grow. This leads to repeated, serious lung infections.

Bronchiectasis can't be cured. However, with early diagnosis and treatment most patients can live a normal life. The sooner your doctor can start treating your bronchiectasis and any underlying conditions, the better the chances of preventing further damage to your lungs.


Chronic cough is defined as a cough that persists beyond four to eight weeks. The most common causes of chronic cough include tobacco smoke, asthma, COPD, gastric reflux, allergies, medications or post-nasal drip. Once a chest x-ray is ordered other diagnoses may come to light including congestive heart failure, bronchiectasis, interstitial lung disease, infections or sarcoidosis.

It is important to establish a firm diagnosis to facilitate proper treatment.


COPD is the 4th leading cause of death in the U.S. The two major forms are chronic bronchitis and emphysema.

COPD is characterized by shortness of breath, chronic sputum production, wheezing and cough. It is typically associated with a history of tobacco use.

Appropriate diagnosis with formal breathing tests is important to guide medical treatment and predict long term prognosis.

Tobacco cessation is imperative and reduces the rate of decline of overall lung function.

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HEMOPTYSIS - Coughing Up Blood

Hemoptysis is defined as the act of coughing up blood from the lungs or air (bronchial) tubes. It can be frightening to individuals and vary in amount. All amounts should be evaluated by a physician. Massive hemoptysis is defined as >200 mL of blood within 24 hours and should be seen by a physician as soon as possible. As massive hemoptysis can be life threatening, it warrants a more aggressive, expedient approach where diagnosis and therapy must occur simultaneously. These patients require intensive care and early consultation with an interventional pulmonologist.

Common causes of hemoptysis include acute and chronic bronchitis, pneumonia, tuberculosis, bronchiectasis, infections, and lung cancer. To determine the correct cause, a thorough physical exam, review of current medications, laboratory testing and imaging are necessary. If no cause is immediately found, bronchscopy may be needed to directly visualize the airways.


Lung cancer is the number one cause of death in men and women in the United States each year. It is defined as the uncontrolled growth of abnormal cells in the lung. There are 2 main groups: non-small cell lung cancer and small cell lung cancer. Risk factors for developing lung cancer include tobacco smoke, radon, asbestos, air pollution, family history of lung cancer, personal history of lung cancer and age > 65.

Early lung cancer rarely causes symptoms. As the disease advances, vague symptoms such as cough, chest pain, shortness of breath, coughing up blood and weight loss may occur.

Diagnosis is important for treatment and staging of the cancer. Typically doctors start with a physical exam and chest x-ray which may then lead to a CT scan of the chest. Once a mass, chest fluid or enlarged lymph node is found, a variety of procedures may help with diagnosis and staging. All of these options will be discussed between patient and physician.

Treatment will vary based on the stage and type of lung cancer.

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A lung nodule is a spot on your lung that may be due to cancer, infection or scarring.

Lung nodules may need to be evaluated with chest x-rays, CT scans and/or bronchoscopy by your pulmonologist.


Pleurisy is defined as inflammation of the lining of the lungs that causes pain when you take a deep breath or cough. The main symptom of pleurisy is pain in the chest or shoulder. Deep breathing, coughing, and chest movement can make the pain worse.

Causes may include cancer, asbestos related disease, infection (viral or bacterial), chest trauma, pulmonary embolus or rheumatic diseases. Pleurisy can cause fluid to collect inside the chest cavity. This can make breathing difficult and may lead to coughing, shortness of breath or rapid shallow breathing. The fluid seen on chest x-ray or heard on physical exam may need to be drained (thoracentesis) and/or sent for further analysis.


Idiopathic pulmonary fibrosis is scarring or thickening of the lungs without a known cause. The disease can occur at any age but appears most often between age 50 and 70 years.

Pulmonary fibrosis causes the lungs to become scarred and stiffened. This stiffening may make it increasingly difficult to breathe as the lungs lose their ability to transfer oxygen to the bloodstream. In some people the disease gets worse quickly (over months to a few years), but other people have little worsening of the disease over time.

Symptoms include shortness of breath with exertion, chronic dry, hacking cough, fatigue, weakness, discomfort in the chest, loss of appetite and weight loss.

Unfortunately to date there is no cure for pulmonary fibrosis. There are clinical trials on-going.

Pulmonary fibrosis may be associated with a variety of diseases including rheumatoid arthritis, lupus, ingestion of certain medications and also occupational exposure (e.g. asbestos, silica).

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Pulmonary Hypertension is defined as increased pressure in the pulmonary arteries that supply blood flow to the lungs. The walls of the arteries may harden or become blocked by blood clots leading to increased work on the right side of the heart. Symptoms of the disease are often vague. These include shortness of breath, fatigue, chest pain, lower extremity swelling or racing heart rate. If not diagnosed or treated early, the disease can lead to congestive heart failure.

There are a variety of reasons that people develop pulmonary hypertension. These include genetic pre-disposition, COPD, untreated sleep apnea, sickle cell disease, sarcoidosis and mitral valve disease.

Initial treatment is based on the stage of the disease at diagnosis. Medication options range from pills to continuous IV. There is no cure for the disease at this time. Research and clinical trials are on-going.

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Airway stenosis or strictures may lead to shortness of breath, wheezing and/or recurrent chest infections because of difficulty clearing secretions. A partial list of causes includes:

  • Wegener's Granulomatosis
  • Sarcoidosis
  • Relapsing Polychondritis
  • Translaryngeal Intubation Injuries
  • Foreign Body Aspiration
  • Papillomatosis
  • Tuberculosis
  • Trauma
  • Vascular Anomaly

Drs. Fields and deKeratry are experts in the management of airway strictures and use Interventional Pulmonology techniques including cryotherapy, argon-plasma coagulation, electrocautery, topical chemotherapy and airway prosthetics (stents). Please see our section on Therapeutic Bronchoscopy.

PHONE (512) 819-0132 | FAX (512) 819-9335 | 1900 Scenic Drive Suite 2208 Georgetown, TX 78626