(September 9, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
At the recent American Thoracic Society conference in Toronto, we caught up with Dr. Marvin Schwarz, MD, who is the James C. Campbell Professor of Pulmonary Medicine, in the Division of Pulmonary Sciences & Critical Care Medicine at the University of Colorado Health Sciences Center.
If I had shortness of breath…
If I had unexplained shortness of breath, I would not ignore that symptom. If I smoked cigarettes I would stop smoking those cigarettes. I would go to my physician, my primary care physician and say; “I’m having recent shortness of breath, its coming on I feel it. There is a distinct change. What’s causing it?” It maybe something as simple as emphysema if you smoke. Stopping smoking and getting various therapies for the emphysema will keep you alive for a long time. If it is interstitial lung disease, when it turns out that when we get the testing, and the results point toward that diagnosis, you should make a request to see a pulmonary physician. Who could further characterize this disease for you in terms of causation, the staging of the disease, how far along it is, potential therapies, referral to trials, etc.
What are the symptoms of an interstitial lung disease?
The symptoms of an interstitial lung disease are primarily shortness of breath and sometimes cough. Sometimes only shortness of breath. You may recognize this as exercise intolerance, you just might notice that in your daily living activities you have to stop and rest. You just feel that like bit of discomfort, feeling a little bit of air hunger, and when you rest and it goes away. Those are the primary symptoms of shortness of breath.
How should my doctor assess the problem?
The most common cause of shortness o breath is probably cardiac disease. He will probably evaluate that, he might do an echocardiogram, he might do an EKG. If he suspects lung disease he’ll start with a chest x-ray. He’ll do pulmonary function testing and then likely he will do a CT scan of the chest. The evaluation, assuming that the cardiac studies are negative, and that the chest x-ray is negative, and you are still short of breath, I think that as a patient you should insist on getting a high resolution computed tomographic scan of the chest. A number of lung conditions can cause shortness of breath. The three most common are asthma, what we call COPD or emphysema, and interstitial lung disease. Interstitial lung disease is a general term for a number of diseases which can cause scarring in the lung. Most often these diseases are progressive. The diagnosis of them would be best to do early.
What are the risk factors for the developing an interstitial lung disease?
If you have what is known as collagen vascular disease, such as lupus, rheumatoid arthritis, scleroderma, polymyositis, mixed connective tissue disease, if you have any of these diagnoses your incidence of interstitial lung disease increases markedly. Other things that can result in interstitial lung disease are drug reactions . There are a number of drugs which can cause interstitial lung disease. If you have been put on a new medication and several months later, sometimes even days later, you can become short of breath. These are very reversible by simple treatment and discontinuation of that particular drug. There are other causes, occupational exposures for instance. If you have worked with asbestos during your life, and there are a number of others but I cant go through the whole list. So you have to think about your occupational exposure. There are environmental exposures, which can cause it. There is a disease entity known as hypersensitivity pneumonitis, and this is a reaction to something in your environment, usually some bacteria, or some fungus, that you get sensitized to. Smoking cigarettes for example can cause interstitial lung diseases. We think mainly that it causes obstructive lung diseases, or COPD/emphysema type of illness. But there are three or four interstitial diseases that can result from smoking cigarettes.
What treatment options are available?
This is problematic in terms of treatment. It really depends upon which particular interstitial lung disease that you have. For example if it is drug induced you take away the drug, you can give a medication known as cortical steroids that help clear it up. It you have a collagen vascular disease, often time the standard treatment for a collagen vascular disease will also help improve the interstitial lung disease associated with it, sometimes not however. If you have this environmental exposure issue, hypersensitivity pneumonitis, and just taking away that particular stimulus for the reaction of hypersensitivity pneumonitis may be the only treatment required. Our biggest problem is when you already have scarring in the lung. The thing called fibrosis. This is where we have the largest problem, and so far depending again on the disease that’s causing this fibrosis, the treatment is not so good. We are now engaged in many treatment trials for these diseases. I would recommend if you are a patient with one of these fibrotic disorders that has no known cause, what’s called the idiopathic variety. You should strongly consider a treatment trial with some of these newer agents. Because the agents we have now are not that helpful. The other issue is if your disease advances in spite of whatever treatment is prescribed to you and you are not much over the age of 65, lung transplantation is another option.