Thoracentesis (also known as a pleural tap) is a procedure to remove fluid or air from the pleural space. The pleural space is an area between the lung and the chest wall that usually contains just a thin layer of fluid. At times, air or more commonly fluid can collect in this space. If there is enough fluid, a patient can become symptomatic, for example develop shortness of breath. If that occurs, removal can provide relief of these symptoms. Additionally, fluid may need to be removed to help aide in the diagnosis of many conditions. The test is performed as follows: You will sit on the edge of a bed or chair. Your head and arms will rest on a table. The skin around the procedure site is cleaned and the area is draped. A local numbing medicine (anesthetic) is injected into the skin. You will feel a stinging sensation when the local anesthetic is injected. The thoracentesis needle is inserted above the rib into the pleural space and a catheter (small plastic tube) if introduced. You may feel pressure when the needle is inserted into the pleural space. Fluid is collected and will be sent to a laboratory for testing. This procedure has been performed by physicians since 1852!

Flexible Bronchoscopy

Flexible Bronchoscopy

Cystic fibrosis (CF) is an inherited condition caused by a defective gene (CFTR – Cystic Fibrosis Transmembrane Conductance Regulator) which causes the body to produce abnormally thick and sticky fluid, called mucus. This mucus builds up in the breathing passages of the lungs and in the pancreas, the organ that helps to break down and absorb food. This collection of sticky mucus results in life-threatening lung infections and serious digestion problems. The disease may also affect the sweat glands and a man’s reproductive system. Millions of Americans carry the defective CF gene, but do not have any symptoms. That’s because a person with CF must inherit two defective CF genes – one from each parent. An estimated 1 in 29 Caucasian Americans has the CF gene. The disease is the most common, deadly, inherited disorder affecting Caucasians in the United States. It’s more common among those of Northern or Central European descent. Most children with CF are diagnosed by age 2. A small number, however, are not diagnosed until age 18 or older. Occasionally, relatively mild symptoms may lead to frequent misdiagnosis or no diagnosis at all unless the symptoms become worse. The condition may be misdiagnosed as emphysema, asthma or chronic bronchitis. These patients usually have a milder form of the disease. About 30,000 Americans and 70,000 people worldwide are living with cystic fibrosis. Only a few decades ago, children with CF seldom survived elementary school. Today, thanks to earlier diagnosis and improved treatments, the median survival for those with CF is 47 years of age. With new, novel therapies known as CFTR modifiers this number is likely to climb.

Dr. Schaefer helped to establish the Adult Cystic Fibrosis Program at the UMass-Memorial Medical Center. He sees patients with CF at the CF Center at UMass-Memorial University campus, as well as in MLA’s Worcester office.

UMass-Memorial / UMass Chan Medical School Adult Cystic Fibrosis Program

The UMass-Memorial Adult Cystic Fibrosis Center, accredited by the national Cystic Fibrosis Foundation, specializes in the management of adults with cystic fibrosis. We provide a team approach to care that includes medical, nurse, registered dietician, physical therapy, social worker, and respiratory therapy cystic fibrosis specialists. We collaborate closely with our colleagues in the UMass-Memorial Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care.

Our services

  • Comprehensive cystic fibrosis diagnosis including sweat testing and blood testing for all known mutations related to cystic fibrosis.
  • Full range of treatments for all complications related to cystic fibrosis, including those involving the respiratory, sinus, digestive, endocrine, and reproductive systems.
  • Up to date therapeutics including use of the newest CFTR Modulators
  • Management of cystic fibrosis lung disease, including mucus clearance techniques, mucolytics, and preventive therapy for patients infected with pseudomonas.
  • Comprehensive nutrition counseling and care, including pancreatic enzyme replacement therapy, screening for and repletion of vitamin deficiencies.
  • Bronchoscopy is a procedure used to visualize the inside of the airways (bronchial tubes). It is used for both diagnostic and therapeutic purposes. The bronchoscope is a flexible instrument that is inserted into the airways, usually through the nose or mouth. It has both a light source and digital camera at its end. This allows the physician to examine the patient’s airways for abnormalities such as tumors, bleeding, foreign bodies, or inflammation. At the time of the bronchoscopy specimens may be taken from inside the lungs such as biopsies, fluid, or brushings. The procedure can be accomplished as an outpatient with the use of sedation, similar to that used for a colonoscopy.You may be referred to MLA by your physician for abnormalities such as a nodule or mass found on an x-ray or CT scan, or for the evaluation of persistent or recurrent pneumonia. Your MLA physician will review all the specifics of this test if he or she decides this would be the best study for you.
  • Close collaboration with Nutrition, Psychology, Respiratory Therapy, Gastroenterology, Endocrinology (diabetes), Transplant Surgery and Palliative Care.

Pulmonary Function Tests (PFTs)

Pulmonary Function Tests (PFTs)

Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body’s circulation.

Pulmonary function tests are done to:

  • Diagnose certain types of lung disease (most commonly asthma, chronic bronchitis and emphysema)
  • Help find the cause of shortness of breath
  • Assess the effect of medication to treat your lung disease
  • Assess the effect of medication prescribed to treat your lung disease
  • Assess the effect of medication that may negatively affect your lung function (for example, amiodarone)
  • Measure progress in disease progression
  • To assess perioperative pulmonary risk prior to undergoing surgery

The most commonly performed test is called “spirometry.” With this test you will breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time. For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. You will be asked to wear a nose clip so we can collect all the air that comes out of your mouth. “Lung volume” is measured in other ways. In one way you will be asked to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.

Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. For one test known as a “methacholine challenge test” you will have to breathe in medication before the test.

Do not eat a heavy meal before the test. Do not smoke for 4 – 6 hours before the test. You’ll get specific instructions if you need to stop using bronchodilators or inhaler medications prior to the test. The tests are usually very well tolerated. Since the test involves some forced and rapid breathing, you may have some temporary shortness of breath or light-headedness.

Allergy Shots (Immunotherapy)

Allergy Shots (Immunotherapy)

Immunotherapy, also known as “allergy shots” is a way of making the body less sensitive to specific substances known as allergens. With reduced sensitivity comes a reduction in your allergy symptoms. Allergic sensitivity is determined by allergy skin tests, or blood tests. This information is used to determine which allergens contribute to your reactions. Mixtures of these allergens are then developed for your therapy. The mixtures are given by injections under the skin.

By starting with extremely tiny doses and gradually increasing, the immune system becomes more tolerant, and thus your allergy symptoms are reduced. There are 2 stages of immunotherapy. Build-Up: This is the 1st stage when the amount of each injection is slowly increased. Most patients receive injections once per week, though if your schedule allows, you can come twice weekly. There are about 25 steps to complete this 1st phase. During this phase some but not all of our patients notice any improvement in their symptoms. Maintenance: The 2nd stage. Once you have reached the highest dose of each mixture, that dose is repeated once a month. Benefits from immunotherapy have been shown when a patient reaches this dose. Because of the potential risk of an allergic reaction, shots are only given by medical professionals trained in the proper administration, and in the recognition and management of complications. For this reason shots are given in the MLA Worcester office only.

There is a 20-30 minute observation period after each shot during which you will wait in the office to be sure that you do not have an allergic reaction. At least 80% of patients who receive immunotherapy have a significant improvement in their allergy symptoms, although many do not feel completely “cured.” Not everyone is able to stop taking all of their allergy medications. Allergy shots do not cure you of your allergies, only make you more tolerant upon allergen exposure or during your season. If therapy is stopped some of the symptoms may return, though most individuals have some long-lasting benefit well beyond the time the shots were discontinued. Because of the need to maintain a regular injection schedule, immunotherapy should not be started unless your schedule allows for fairly regular visits.

If your symptoms are troublesome despite avoidance strategies and medications, allergy immunotherapy may be right for you.

Sleep Study Resources and Sleep Disorder Information

Sleep Study Resources and Sleep Disorder Information

Mass Lung & Allergy Sleep Center Update:

Mass Lung and Allergy is currently offering Home Sleep Test device pickups from both our Leominster and Worcester offices! Call us at 774-420-2611, option 5 for more information.

Home Sleep Testing Instructional Video

Sleep Disorders:

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common problem that affects a person’s breathing during sleep. A person with OSA has times during sleep in which air cannot flow normally into the lungs. The block in airflow (obstruction) is usually caused by the collapse of the soft tissues in the back of the throat (upper airway) and tongue during sleep. For more information on OSA click here.


Many people experience difficulty sleeping. Some people have short periods (days to a few weeks) of difficulty falling asleep or staying asleep (called acute insomnia). Others have this difficulty for a month or longer (called chronic insomnia). About 30% of Americans complain of having insomnia. Insomnia can be very disruptive to a person’s life, so understanding insomnia and what can be done to treat it can be helpful to your quality of life. For more information on insomnia click here.


Narcolepsy is a neurologic problem in which your brain is not able to control your sleep-wake cycle. It can cause you to have sudden and overwhelming sleepiness any time of the day. This can cause you to fall asleep at inappropriate times, such as while talking to someone, driving a car, eating, or while at school or work. This can at times put you in danger such as when driving. Narcolepsy is a lifelong condition that never goes away. About 1 in 2,000 people have narcolepsy. It affects men and women equally. Most people with narcolepsy will begin to have symptoms between the ages of 10 and 30 years old. For more information on Narcolepsy click here.

Allergy Testing

Allergy Testing

When suspicion is raised about a possible allergy, your allergist will first get more details from your history. Do the symptoms suggest an environmental allergy such as sneezing, nasal congestion and itchy eyes? Perhaps symptoms developed after ingestion of food or after an insect sting. He or she will want to know about any symptoms of asthma as well as family history. The medical history serves as a basis for the allergy diagnosis and may then lead to confirmatory testing. There are 2 primary forms of testing, the skin test – which gives the fastest and most accurate results – and the allergy blood test.

A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as many as 50 different substances at once. This test is usually done to identify allergies to pollen, mold, pet dander, dust mites and foods. In adults, the test is usually done on the forearm. Children may be tested on the upper back. Skin prick testing provides results in about 20 minutes. A liquid containing a tiny amount of the food allergen is placed on the skin. Your skin is pricked with a small, sterile probe, allowing the liquid to seep under the skin. Multitest devices now allow for 8 or 10 tests to be applied simultaneously, making the process even easier. To see if your skin is reacting normally, two additional substances are scratched into your skin’s surface. Histamine (positive control) – in most people, this substance causes a skin response. If you don’t react to histamine, your allergy skin test may not reveal an allergy even if you have one. Glycerin or saline (negative control – in most people, these substances don’t cause any reaction. If you do react to the negative control, you may have sensitive skin. Test results will need to be interpreted cautiously to avoid a false allergy diagnosis. The test isn’t painful.  You won’t bleed or feel more than mild, momentary discomfort. The test is considered positive if you develop a raised, red, itchy bump (wheal) that may look like a mosquito bite. The nurse will then measure the bump’s size and record the results. Next, he or she will clean your skin with alcohol and may apply a topical steroid. When the test is over, the doctor or nurse will clean your skin and put some cream on it to help with any itching.  Any swelling from a reaction usually goes away within 30 minutes to a few hours. Some medicines can get in the way of the tests. Check with your doctor to see if you need to stop taking any medication before the test.

If you take medicine that could affect allergy test results, have sensitive skin, or have had a bad reaction to a skin test, your doctor might do a blood test instead. A sample of your blood is sent to a lab, and your doctor will typically get the results in about a week. Allergy blood tests, which are a bit less exact than skin tests, measure the amount of IgE antibody (“allergic antibody”) to the specific allergen being tested and are reported as a numerical value. This is typically more expensive than a skin test.

Your allergist will use the results of these tests in making a diagnosis. If an allergy test is negative, you aren’t allergic to that substance. It’s rare to get a false (incorrect) negative allergy test result (meaning the test says you don’t have an allergy when you actually do). A positive test however does not mean you have an allergy – or at least react to that allergen. A false positive test result is possible, especially from a blood (IgE) test. A false positive means the results show you have an allergy when in fact you don’t.

In some cases, a skin or blood test is not available, or the results are not conclusive. In those cases, an allergist may recommend an oral challenge. This is considered the most accurate way to make a food allergy diagnosis. During an oral food challenge, which is conducted under strict medical supervision, the patient is fed tiny amounts of the suspected trigger food in increasing doses over a period of time, followed by a few hours of observation to see if a reaction occurs. Because of the possibility of a severe reaction, an oral food challenge should be conducted only by experienced allergists in a doctor’s office or at a food challenge center, with emergency medication and equipment on hand.

Preparing for Allergy Skin Testing

There are certain medications that can interfere with the performance of an allergy sin test and therefore limit its value. For that reason, it is important to review the list below.

Medications MUST be stopped for at least 7 to 10 days prior to allergy testing

Antihistamines – “Allergy medications”  (Brand name / Generic name)

  • Allegra (fexofenadine)
  • Chlor-Trimeton (chlorpheniramine)
  • Zyrtec (cetirizine)
  • Xyzal (levocetirizine)
  • Claritin (loratadine)
  • Clarinex (desloratadine)
  • Benadryl (diphenhydramine)
  • Atarax (hydroxyzine)
  • Astelin/Astepro (azelastine) allergy nasal spray needs to be stopped
  • All allergy eyedrops need to be stopped

Medications used for Heartburn may be an antihistamine and must be stopped

  • Pepcid (famotidine)
  • Zantac (ranitidine)
  • Tagamet (cimetidine)

Please contact the office if you are taking any of the following medications:

  • Oral steroids (prednisone, methylprednisolone, dexamethasone)
  • Tylenol PM (And all other “PM” medications) – these contain Benadryl
  • Antidepressants (amitriptyline, nortriptyline)

If you have ANY questions about your medications, please call the office 774-420-2611

Biologic Therapy for Asthma

Biologic Therapy for Asthma

For some patients with asthma avoidance of triggers and inhaled (and oral) medications are not enough to control their asthma.  Recently, several new medications, known collectively as “biologics,” have been approved for the treatment of moderate-to-severe asthma. The term “biologic” is used for medications and other healthcare products that are made from living animals, plants, or cells, instead of through a chemical process. Biologics include a wide range of products, such as vaccines and blood products, as well as medications used to treat certain medical conditions (e.g., insulin for diabetes). Biologic therapies offer new ways of treatment because they target different molecules in the body that contribute to asthma. Biologic therapies can treat some types of severe asthma by helping to stop body processes that cause inflammation of the airways. This inflammation that may be caused by allergies or by high levels of a cell in the body called an eosinophil. Eosinophils are a type of white blood cell linked to inflammation. People with severe asthma sometimes have high levels of eosinophils in the blood.

If your provider is considering using a biologic to treat your asthma, the biologic would be added to the reliever and controller medications you are currently taking. Biologics do not replace these medications, although some people may find that they are able to reduce the dose of their controller medication after several doses of a biologic. Please note that you should only reduce the dose of your controller if your specialty provider tells you to do so.

Several options are available for biologic therapy in treating severe asthma with the so called allergic or eosinophilic phenotype. Severe allergic asthma where severe symptoms are triggered by allergies. This type of asthma mostly starts in childhood. Omalizumab is a biologic that targets severe allergic asthma, reducing the allergic response. Eosinophilic asthma where severe symptoms are triggered by higher levels of cells called eosinophils. This type of asthma is usually associated with adult-onset asthma. Mepolizumab, reslizumab and benralizumab are all biologics that target severe eosinophilic asthma, by reducing eosinophils.  Severe asthma with type 2 inflammation where severe asthma symptoms are driven by both allergies and high levels of eosinophils. Dupilumab is a biologic targeting severe type 2 inflammatory asthma. It works by damping down the inflammatory response. The most recently approved biologic is a drug known as Tezepelumab. This targets an entirely different aspect of the asthma inflammatory cascade.  Most of the therapies are given as an injection, either in the office, or using pre-filled syringes at home. Reslizumab is given through an intravenous infusion. Biologic treatment is given as an injection at your doctor’s office or special clinics, usually every 2 to 4 weeks, depending on the particular medication.

As with all medicines, biologic treatments can have risks and side effects. Some common side effects (affecting up to 1 in 10 people) include: headache, sinus pain, sore throat, soreness at the injection site (this should pass in a few days and may improve after you’ve had the injection a few times). Biologic treatments for asthma have an increased risk of a severe allergic reaction (anaphylaxis). The risk is rare (1 in 1000 or more) and more likely if you have a history of allergic reactions or anaphylaxis.  This is not a complete list of the side effects that may happen with biologics; if your doctor is considering a biologic for you, please make sure to ask about the possible side effects that could happen with the specific medication you will be using.

There are currently no set recommendations on how long a patient should be on a biologic.  Guidelines recommend trialing the medication for at least four months to see if it is helping improve your asthma.  Your specialist may use tests to assess your status such as spirometry, FeNO, and blood tests. Whatever biologic you are prescribed, you will need to review your treatment regularly with your provider. Your doctor will work with you to decide how long to keep you on a biologic if your asthma is under good control. Contact your healthcare team if your asthma symptoms are not improving or are getting worse. Do not stop taking either your usual asthma medicines or your biologic treatment unless your doctor tells you to. If your treatment’s not working for you, or you’re getting difficult side effects, your specialist may stop treatment and look at other options.

Zephyr Endobronchial Valve

Zephyr Endobronchial Valve

A New Treatment Option for Severe Emphysema

Your doctor offers a new procedure to help you with severe emphysema. It is called the Zephyr® Valve treatment. The Zephyr Valve treatment is a procedure that allows a doctor to place one or more small valves in your airways, which release trapped pockets of air to improve your ability to breathe. It is not a medicine and it is not surgery.

Other Treatment Options

Emphysema cannot be cured; however, treatment may help
reduce symptoms, improve quality of life, and slow progression of the disease.

Current Emphysema Treatment Options:

  • Stop smoking
  • Medication
  • Long term oxygen therapy
  • Pulmonary rehabilitation
  • Surgical lung volume reduction
  • Lung transplant