Learn how local health experts confront lung cancer, COPD and asthma.
By now, you’ve obviously heard a lot about COVID-19 as a respiratory illness. But what other respiratory illnesses do physicians encounter?
Learn from local medical experts as they deep-dive into other lung diseases and disorders they commonly confront.
Lung Cancer
While it may be frightening to learn about a lung cancer diagnosis, it’s important to remember – treatment for that diagnosis doesn’t mean an automatic end to your quality of life.
“Actually, to inspire hope, I give the patient numbers,” says Dr. Ismael Shaukat, a hematologist/oncologist at the Patricia D. Pepe Center for Cancer Care at OSF Saint Anthony Medical Center, in Rockford.
True, the numbers initially may cause concern. Lung cancer, by far, is the leading cause of cancer death among both men and women, according to the American Cancer Society. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.
But, the number of deaths from lung cancer are dropping off, thanks to advances in both screening and treatment. And, perhaps most importantly, the numbers improve as people quit their smoking habits.
“Years ago, the conversations we used to have were telling patients they had months to live,” Shaukat says. “Now, that has changed tremendously. Now, patients may have years to live, and they’re seeing that for themselves. You know, they’re initially very skeptical of what I say, but as they live longer and start feeling better without any significant side effects, they begin to see this as well.”
A major positive contribution to lung cancer treatment has been the incorporation of immunotherapy into patient regimens, Shaukat explains. Immunotherapy, a relatively new form of treatment, uses the body’s own system to fight off cancer cells.
“More specifically, we use our body’s T-cells to fight off cancer cells,” Shaukat explains. “All of us usually have T-cells that are normally working to fight off viruses and bacteria on a regular basis. But, immunotherapy enhances the activity of the T-cell. Obviously, there’s some side effects that can occur, but overall, 80% of patients do not experience any side effects.”
According to Shaukat, immunotherapy initially began as a treatment modality for melanoma back in 2011. But fortunately, since then, it has been found to have an effect on a wide range of diseases, including lung cancer.
The addition of immunotherapy has been especially profound for stage-four lung cancer patients, Shaukat adds.
“So, obviously, stage four has a limited lifespan,’ Shaukat explains. “Before, patients did not do very well with the standard treatment, which was just chemotherapy. But, with the addition of immunotherapy, we have seen an increase in survival of years rather than patients having months to live initially in the pre-immunotherapy era.”
Another break-through in treating lung cancer, specifically for adenocarcinomas – the most common type of lung cancer – has been the addition of molecular testing, Shaukat adds. Essentially, there’s a list of mutations that can occur, and if detected, Shaukat can give targeted therapy in the form of a pill so that a patient can bypass chemotherapy and immunotherapy altogether, at least initially.
“Patients have quite impressive responses,” Shaukat says. “Unfortunately, they’re not permanent. But, this treatment does offer palliation for some time, perhaps six to nine months, and provides a great quality of life during that interim period.”
Screening for lung cancer is also fairly new over the past 10 years, Shaukat adds. Since smoking is the main cause of lung cancer, screening has particularly made a difference in individuals between 55 and 75 years of age, who have smoked about a pack of cigarettes per day for about 30 years.
“The incidence of lung cancers in the United States is about 230,000, with at least 135,000 deaths that occur from this. And, 90% of lung cancer cases are caused by smoke – usually it’s firsthand smoke, but secondhand smoke also contributes to this,” Shaukat explains. “Obviously, there’s other etiologies as well, but they’re way down on the list, including environmental toxins. But, by far, smoking is the number one cause.”
So, as of right now, patients who are 55 to 75 years of age with a smoking history of one pack per day for at least 30 years or more are recommended to undergo a low-dose CT-scan to be screened for lung cancer.
Shaukat himself has lost a family member to cancer, so, for him, it’s a personal mission to help his patients fight off their cancer so that they no longer have evidence of disease.
“My passion is to help people – their well-being is of utmost importance,” he says.
COPD
Just as smoking increases a person’s risk for developing lung cancer, it also increases a person’s risk of developing chronic obstructive pulmonary disease (COPD) – a disease that causes obstructed airflow from the lungs.
“COPD is a very insidious disease. I mean, it really sneaks up on people,” says Dr. Timothy Jessen, a board-certified allergist/immunologist at FHN. “I’m always amazed by how advanced it can get because people just write it off. They say, ‘I’m a cigarette smoker, and I’m getting short of breath when I move around, but I’m older now, so maybe I’m just getting old.’ People can just keep talking to themselves until finally, at some point, they say, ‘You know what, I can’t do anything anymore, so I’m going to need to get this looked at.’”
COPD usually results in smokers and can include both emphysema and chronic bronchitis, Jessen explains. Emphysema is a condition in which your alveoli – tiny air sacs where oxygen and carbon dioxide exchange – are destroyed as a result of exposure to smoke.
Chronic bronchitis occurs when there’s irritation in your bronchial tubes, which carry air to and from your alveoli. Because of this chronic irritation, the glands in your lungs produce more mucus.
“As terrible as it sounds, you can essentially tell how bad someone’s doing by how much goo they cough up,” Jessen explains. “That’s the chronic bronchitis portion, and COPD is usually characterized by both chronic bronchitis and emphysema. You very seldom have one without the other because smokers are the normal population of people with these diseases.”
While COPD can worsen over time, the good news is there is treatment available.
“The best thing you can do is convince someone to stop smoking if they haven’t already,” Jessen says.
“Otherwise, the disease will just continue to advance. But there is actually some therapy that patients can do for COPD based on how severe the obstruction is. And then there’s also inhalers you can use to manage your symptoms.”
Treatment for COPD has been fairly consistent over the past several years, Jessen says. However, inhalers themselves have improved.
“For decades, there have been three categories of medications,” Jessen explains. “But, for the past several years, people have been jockeying around which medicine goes in what inhaler and what combination of medicines go together, so now there’s an inhaler that has all three categories of medications. We didn’t have that before. We had all of the medications, but we didn’t have them all together in the same inhaler.”
But, despite all of the inhalers and therapy available, a COPD patient’s No. 1 priority should be to quit smoking, Jessen emphasizes. And obviously, it’s easier said than done.
“Yeah, it’s tough,” Jessen admits. “What I tell people is, there isn’t one right way to quit smoking. You have to figure out what’s going to work for you. And unless somebody is ready to quit smoking, and they really want to, you could talk to them all day, but it’s never going to happen.”
According to Jessen, a person’s success rate for quitting smoking without any medication is around 20%. With medication, that rate increases to about 30-40%.
“The odds of quitting heroin are better than your odds of quitting cigarettes,” Jessen says. “That sounds like a crazy statement, but it’s true. And, keep in mind, you are not considered a stable nonsmoker until you have not smoked for a full year. So, it becomes very, very challenging. And some people literally just don’t stop until they’re on oxygen, and then they can’t smoke anymore because they’ll literally start on fire. It’s really one of those things where you just have to keep chipping at it.”
Jessen makes sure to take a non-judgmental approach when treating his patients who are trying to quit smoking. Though he wants to take care of them, he also doesn’t want to push them out the door.
“Everybody has a different approach, so for me, I really like to see what kind of partnership I can make,” Jessen says. “Anything I can do, I’m willing to do for you. And the other thing I tell folks is, again, your odds of quitting are about 20% without medication, and they’re much better with medication. So, my comment is never quit quitting. If you quit and it doesn’t work, regroup and try again. I think the average person probably tries four or five times before it sticks.”
Asthma
Asthma is a common disease process – there are more than 3 million cases in the United States per year, according to Mayo Clinic – and, to this day, treatment of asthma continues to improve.
Treating asthma is a passion of Dr. Abdullah Altayeh, pulmonologist and director of critical care at Mercyhealth.
“Asthma is one of my favorite topics,” he says. “It has a bimodal variation. So, you can get it when you’re young, and it will get better, sometimes when you’re a teenager, and maybe it will actually go away. And then, it will come back when you get a little bit older – into your late 20s, 30s, and 40s. It’s been linked to a strong family history of allergies.”
Asthma is a condition in which your airways narrow, causing breathing difficulties. For some patients, it’s just a minor nuisance. But for others, asthma can be life threatening.
Usually, extreme weather temperatures or exposure to environmental toxins causes asthma to reemerge, Altayeh explains. When patients come to him with classic asthma symptoms, such as a dry cough, wheezing, or chest tightness, he typically administers a pulmonary function test to measure the patient’s lung capacity.
“So, they’ll do that breathing test initially,” Altayeh says. “Then, we give them an inhaler to see whether or not there’s a significant improvement in their lung capacity.”
There’s also another breathing test, called the methacholine challenge test, where Altayeh actually gives very small doses of a medicine to purposefully trigger an asthma attack. If there’s a detrimental decrease in the patient’s lung capacity by about 19%, then they can be officially diagnosed with asthma.
Finally, Altayeh can administer allergy testing, called a rash panel, to test patients for 20 specific allergies that pertain to triggering asthma attacks.
“If you have asthma, you need to be very diligent and understand what your triggers are,” Altayeh explains. “Avoiding them is the main factor here. If you’re allergic to cats or dogs, you shouldn’t have a cat or a dog at home no matter how much you love them. I mean, that’s key. You need to take these extra precautions to avoid asthmatic triggers so that you don’t fall into what we call respiratory distress and eventually respiratory failure.”
Asthma can be divided into four stages: intermittent, mild persistent, moderate persistent, and severe, Altayeh explains. Patients with intermittent asthma may seldom require using an inhaler – maybe about once a month. Mildly persistent patients, who have symptoms at least twice a week, and sometimes may awaken in the night due to a shortness of breath, typically need a short-acting beta agonist, commonly known as albuterol, to experience quick relief of asthma symptoms.
“Most asthma patients will be able to get away with just the occasional use of this inhaler,” Altayeh says.
But, patients with moderate-persistent asthma may require a steroid inhaler along with their rescue inhaler, Altayeh explains. Steroid inhalers specifically help to reduce inflammation in the lungs, and thus open up airways.
And finally, patients with severe asthma may require a third type of inhaler called a long-acting muscarinic agonist to reduce inflammation.
However, within the past two years, Altayeh has started using a new, better treatment in more severe asthma patients.
“It’s a new, exciting thing that initially developed about five years ago,” Altayeh explains. “Now, we have certain drugs called biological agents, where we give injections to the patients, which work on the immune system to reduce that inflammatory response to these asthmatic triggers that exist in the environment. So, the inflammation in your lungs doesn’t act up as much, plus, you don’t require steroids, which can have a lot of negative side effects long term.”
Biological agents can help even the most severe asthmatic patients to avoid needing a rescue inhaler, Altayeh says.
“These biological agents are at the forefront of medicine,” he emphasizes.
As a final pathway of treatment, Altayeh is also specially trained to do a procedure called broncothermoplasty, where he can maneuver a camera into a patient’s lungs, similar to a endoscopy, and warm up a patient’s peripheral airways with a catheter, which can reduce inflammation in the lungs.
Being one of few physicians qualified to conduct this procedure is encouraging to Altayeh.
“Especially as a critical care physician, I enjoy being able to help people who are very sick go home to their family and loved ones,” he says. “That feeling is very difficult to explain – that beautiful feeling when you’re able to help somebody through difficult times. And that is very rewarding.”