Latest news with #pulmonary
Medscape
26-05-2025
- Health
- Medscape
Primary Care Can Address Complex Lung Diseases, Too
Primary care physicians (PCPs) often face challenges in diagnosing complex pulmonary issues in patients, particularly when nonspecific symptoms appear similar to cardiovascular issues, asthma, or chronic obstructive pulmonary disease. However, clinicians can cover both pulmonary and cardiovascular concerns during an exam, potentially shortening delays in the diagnosis of interstitial lung diseases (ILDs), including pulmonary fibrosis (PF). Tejaswini Kulkarni, MD 'ILDs are complex, chronic progressive diseases with a great impact on a patient's quality of life and survival. These are often underdiagnosed, or there is significant delay in diagnosis after onset of symptoms due to a multitude of reasons,' said Tejaswini Kulkarni, MD, associate professor of pulmonary, allergy, and critical care medicine and director of the interstitial lung disease program at the University of Alabama at Birmingham, Alabama. 'Early intervention can slow disease progression, improve quality of life, and potentially extend survival in ILD patients,' she said. 'For primary care physicians, increased awareness of the signs and symptoms of ILD and early recognition are crucial.' Timely Diagnosis Tools Although most PCPs try to evaluate the root causes of nonspecific symptoms, about 2 in 5 tend to bypass symptom evaluation if the patient is already on inhaled therapy for a pulmonary condition, according to a survey by the American College of Chest Physicians (CHEST). Instead, they often modulate therapy — for what may be an incorrect diagnosis. William Lago, MD 'As a practicing primary care physician, it doesn't surprise me that PF and ILD are generally misdiagnosed or experience delays in diagnosis. These diseases are on the rare side, so when a patient comes to their PCP, that doctor first will opt to rule out heart issues that can quickly end a life,' said William Lago, MD, a family medicine physician with the Cleveland Clinic-Wooster Family Health Center in Wooster, Ohio. 'That said, lung diseases like PF are incredibly difficult to live with and can progress rapidly if untreated,' he said. 'An earlier diagnosis means starting treatments to slow fibrosing of the lungs, and with slowed disease progression, a patient's quality of life is often improved.' In general, high-resolution computed tomography (HRCT) is considered the gold standard for imaging when it comes to detecting ILD. However, only 62% of PCPs said they order HRCT when a patient's chest radiograph shows lower lobe opacity, and only half said they order it when a patient has inspiratory crackles or other abnormalities during a pulmonary exam, according to the CHEST survey. In response, CHEST and the Three Lakes Foundation sponsored a clinician toolkit, which was created by PCPs and pulmonologists to help clinicians better identify, manage, and treat ILDs. The toolkit includes a patient questionnaire, a decision-making module with patient case studies, an online module with in-depth ILD symptoms and sounds of crackles, and videos of radiologic features of ILDs. The project, called Bridging Specialties: Timely Diagnosis for ILD, also includes white papers and podcast episodes on overcoming barriers to diagnosis. 'In working on this initiative with my pulmonary colleagues, I'm already finding myself thinking more about PF and ILDs as potential diagnoses when seeing patients,' said Lago, who served on the Bridging Specialties expert steering committee. 'Between the patient questionnaire, the decision-making module, and the other resources in the clinician toolkit, I can see this having an incredible impact on how we diagnose patients.' This teamwork approach can help PCPs improve diagnosis rates alongside other specialists, said Kulkarni, who also served on the Bridging Specialties committee. 'Many patients present with vague or nonspecific symptoms, and ILDs can mimic other, more common respiratory disorders or coronary artery diseases, along with shared features of older age and history of smoking,' she said. 'The differential diagnosis is complex and often requires a multidisciplinary team of pulmonologists, rheumatologists, radiologists, and pathologists to identify the subtype of ILD.' Other medical societies have created informational resources as well, including the American Thoracic Society's ILD and idiopathic pulmonary fibrosis (IPF) resources and the Pulmonary Fibrosis Foundation's webinars and clinical resources. Jeffrey Horowitz, MD 'My top advice is to go to reputable sources. I've had one patient ask me about drinking hydrogen peroxide to treat their condition, which they read on a forum online. Others have asked about stem cell therapy in other countries, which isn't regulated and can do real harm,' said Jeffrey Horowitz, MD, professor of medicine and division director of Pulmonary, Critical Care, and Sleep Medicine at Ohio State University, Columbus, Ohio. 'Overall, I tell clinicians that if somebody is short of breath, has crackles, and has a normal echocardiogram, it's probably not the heart, so do those pulmonary function studies early,' he said. 'Since most nonpulmonologists don't have substantial expertise in this area, it's a good idea to have patients evaluated at an academic medical center with expertise in ILD, which also opens the doors for patients to be enrolled in clinical trials.' Ongoing Research and Treatments Ohio State, for instance, recently joined the IPF-PRO/ILD-PRO Registry, an industry-academic collaborative started by Duke University, Durham, North Carolina, in 2014 to maintain a registry of patients for potential therapies and clinical trials. 'There can be a sense of nihilism regarding this entire spectrum of fibrotic lung disease, which wouldn't be without merit if we were talking about 20 years ago,' Horowitz said. 'Today, there are a lot of reasons to be optimistic as we're making gains and improving care for these patients.' Numerous clinical trials are underway, including positive phase 3 results for FIBRONEER-IPF from Boehringer Ingelheim. The trial found that nerandomilast, an oral form of a phosphodiesterase 4B inhibitor, improved forced vital capacity (FVC) at 52 weeks, as compared with placebo. The drug hasn't yet been approved for use, but full efficacy and safety data are expected sometime in 2025. In addition, United Therapeutics offers inhaled forms of treprostinil, which was initially approved to treat pulmonary arterial hypertension, as well as pulmonary hypertension associated with ILD. New data indicate the medication could also benefit patients with IPF who don't have pulmonary hypertension, Horowitz said. The ongoing trial is enrolling patients across the United States. Other ongoing studies include lysophosphatidic acid, a bioactive lipid mediator that can affect lung inflammation and fibrosis, and bexotegrast, a dual selective inhibitor of α v ß 6 and α v ß 1 integrins developed to treat IPF. Although Pliant Therapeutics announced the discontinuation of a phase 2b trial in March, early data showed efficacy for improved FVC. 'I'm optimistic that the next breakthrough is just around the corner,' Horowitz said. 'After 15 years of doing high-quality, informative studies, we're now opening the doors for new therapeutic targets, and as long as we keep doing trials, we're going to make a breakthrough that's going to transform care for these patients.' Horowitz and colleagues are also studying the cellular matrix and cell death of fibroblasts, including the way lung cells interact with other cells in an aberrant wound repair response, ultimately leading to lung scarring. The latest research is focused on enhancing cell susceptibility to apoptosis, or cell death, and decreasing disease progression. 'These lung diseases are heterogeneous, just like cancer. So viewed through the lens of cancer biology, different patients with their own fibrotic diseases have underlying mechanisms that drive the disease process,' Horowitz said. 'We're pursuing the idea that, if we can target the metabolic pathways that cells use, it might be beneficial for developing therapeutics.' Additional developments are occurring in diagnosis and patient care as well, particularly with a focus on genetic testing and coordinated care across specialists. 'The landscape of ILD treatment is evolving with the introduction of new pharmacological agents, advanced diagnostic techniques, and improved interdisciplinary care models and offers a brighter outlook for patients and healthcare providers,' Kulkarni said. 'Looking ahead to 2025 and beyond, as our understanding of disease pathogenesis continues to grow, the integration of precision medicine and genetic insights has the potential to make patient-centered, individualized care a reality.' Kulkarni, Lago, and Horowitz reported receiving grants, consulting fees, and serving in advisory roles for numerous pharmaceutical and medical organizations.
The Sun
14-05-2025
- Health
- The Sun
‘Proud' mum who switched to vaping after smoking 20 years ‘left on deathbed' year later – and will die if she lies down
A MUM who was "proud" to quit smoking after 20 years has been "left on her deathbed" and will die if she lies down - after taking up vaping for a year. Loyda Cordero Faliero, 39, says she made the switch from smoking cigarettes to vaping around 18 months ago because she "thought it would be the healthier option". 4 But at the start of March 2025 - after vaping "24/7" for "little over a year" - she was rushed to the emergency department after her oesophagus "closed-up" and she choked on a sip of her drink. Loyda was diagnosed with pulmonary bullae [large air spaces] in her lungs and a collapsed lung, which doctors told her was a result of a build-up of fluid from vaping. The 39-year-old says doctors told her it could "kill her at any moment" if the sacs were to rupture and has to sleep sat up as she could choke to death if she lies down. Loyda was advised to avoid any physical activity and claims she was told that even lifting a gallon of milk (eight pints) would be too strenuous as it could increase the risk of one of the air-filled sacs rupturing. The mum-of-two was forced quit vaping in order to be eligible for surgery to remove the sacs from her lungs - and was warned that if she continued the habit then she might not be alive in five years' time. Loyda, who is now recovering from the potentially life-saving surgery in hospital, says she wants to warn others of the dangers of vaping. Speaking before the surgery, Loyda, from Franklinville, New York, US, said: "My doctor said that my lung collapsed because they were building up with the liquid from my vape and one of the pulmonary bullae ended up rupturing. "My oesophagus is out of place to where the pulmonary bullae sac is putting pressure onto that and if that ruptures, it could cause a bleed on the brain or internal bleeding which could kill me instantly. "It's causing a lot of problems. If I lay down when sleeping instead of sitting up I can choke to death on my own spit or I can suffocate and die. "I literally have to sit up in bed or on a recliner when I sleep because I'm no longer allowed to sleep lying down until after the surgery - it's pretty much a life or death situation. What happens to your body when you stop smoking "It's made me very emotional. I quit something thinking that it was going to be healthier but unfortunately it destroyed me more than it benefited me. "I was so proud of myself for quitting cigarettes and going to something which I thought was healthier. "I have two grown kids and even if they're grown, I'm still a mum. I still have responsibilities and I still want to be here for my grandkids. "Basically I'm on my deathbed and it's a ticking time bomb waiting to go off." Loyda says she experienced breathlessness, nausea, dizziness and pain in the weeks before her hospital admission - but had put it down to her poor overall health. After receiving the diagnosis, she says she was ordered by doctors to stop all physical activity in order to reduce the risk of one of the pulmonary sacs rupturing and killing her. Loyda continued: "I'm not allowed to be active at all as in cleaning, washing dishes or going up and down the stairs. "They say that even lifting a gallon of my milk is overdoing it for my body because the way that my lung has collapsed, it flares me up really bad. "I can't even cook dinner or stand up to do dishes because by the time I'm done with dishes I'm literally crying in pain and gasping for air. "It really has taken over my life more than I ever thought it would. "I was told my doctors that I had to quit vaping in order to be accepted for surgery. "And I can't go back to smoking after the surgery because this is just going to happen to me again. 4 4 "I'm going to be stuck with this health issue for the rest of my life. "The doctors said that if I carried on vaping then within the next five years I would end up on life support and I wouldn't make it because of how badly this damaged my lungs and how badly the liquid has built up in my lungs." After giving up vaping completely, Loyda underwent surgery to have the pulmonary sacs removed from her lungs on April 30. She is now recovering in hospital and wants to help raise awareness and warn others of the potential health problems vaping can cause - and says she believes that it is both more dangerous and harder to quit than smoking cigarettes. Loyda said: "With a cigarette, you can put it out and do what you've got to do but with a vape it's like a cell phone - it's literally stuck in your hand 24/7 and you're hitting it even when you don't want to hit it just because it's there. "It's horrible. Vaping is 100 per cent more dangerous than cigarettes." Smoking vs. vaping VAPING has been touted as an effective tool to help people quit smoking. Though vaping is substantially less harmful than smoking, the habit isn't completely harmless and comes with its own set of risks. The NHS only recommends it for adult smokers, to support quitting smoking. GP and author Dr Philippa Kaye explained to The Sun that the differences between vaping and smoking - and whether one is better than the other - is "complicated". "In a nutshell, vaping is better than smoking, but breathing air is better than vaping at all." Vaping exposes users to far fewer toxins - and at lower levels - than smoking cigarettes. Switching to vaping significantly reduces your exposure to toxins that can cause cancer, lung disease, and diseases of the heart and circulation like heart attack and stroke. These diseases are not caused by nicotine, which is relatively harmless to health. But research has still linked vaping to a higher risk of failure and lung disease. Health risks of cigarettes Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer Smokers are at greater risk for diseases that affect the heart and blood vessels Smoking can cause lung disease by damaging your airways and the small air sacs Smoking can cause cancer almost anywhere in your body It affects overall health too, such as your mouth, eyes, immune system and fertility Health risks of vaping They can cause side effects such as throat and mouth irritation, headache, cough and feeling sick They could lead to tooth decay They could damage heart health They could cause lung disease They could slow brain development Read more on how vaping can affect your health here. Sources: NHS, CDC
