How Doctors Tackle Respiratory Conditions

When it comes to pulmonary medicine, new advancements happening in our region are helping to treat serious conditions, catch cancer earlier and prevent serious illness.

Photo provided by AMITA Health Alexian Brothers Medical Center

Doctors and researchers are always looking for new ways to help patients stay healthy.

In the world of pulmonary medicine there are newer techniques and methodologies that can aid you or a loved one with your lung and/or breathing issues.

Whether it’s the latest flu vaccine or a robotic-assisted procedure to detect early lung cancer, these techniques and treatments are working hard to help you breathe easy.

Lung Cancer

Lung cancer is very prevalent in the Midwest, says Dr. Neeraj R. Desai, an interventional pulmonologist and medical director of pulmonary endoscopy and interventional pulmonology for AMITA Health.

Desai, who is on the Chicago board for the American Lung Association, says the group recently published a report that showed Illinois’s rate of new lung cancer cases is 63 out of 100,000 – significantly higher than the national rate of 58.

Dr. Neeraj R. Desai

“That’s unfortunate, because most of the lung cancers that we’re detecting are later in their stages,” Desai says, noting that 40 percent of new cases are already in Stage 4 – and the survival rate of Stage 4 lung cancer is 0 to 10 percent.

“If I see someone in the clinic and I diagnose them with any stage of lung cancer, two out of 10 will be with us in 5 years,” Desai says. “But the good news is, by detecting early lung cancer, that changes quickly: the survival rate is 92 percent for Stage 1 lung cancer.”

The even better news is that doctors have found a new, less-invasive way to determine whether a person has lung cancer.

Just as mammograms and colonoscopies can help detect breast cancer and colon cancer, a low-dose CT scan can help doctors determine whether someone may be at risk for lung cancer.

Good candidates for an annual scan include someone who has smoked a pack of cigarettes a day for 20 or more years and are between 50 to 80 years old.
“Once we get a CT scan – or if, for any other reason, someone gets a CT scan – and we see an abnormality, or lung nodule, we get concerned whether this is cancer or not,” Desai says. “These findings are very suspicious.”

While the majority of these lung nodules will end up being benign, for years the only way doctors could tell with certainty was to place a needle in a patient’s chest and direct it into the spots.

“There was a very high chance of complications and risk,” Desai says. “We don’t want to put our patients through procedures just to find out they didn’t need surgery, but we didn’t have many tools beforehand to tackle these problems and diagnose these lung nodules.”

Today, however, an ion robotic-assisted bronchoscopy system is available to help doctors navigate the intricate lung system.

“If you had to go to Soldier Field to go to a Bears game, and you had to park in one of those lots and you had no idea where they were, now you can put it in your GPS and it will take you there with very a high level of accuracy,” Desai says. “With the help of robotic-assisted bronchoscopy, it’s like a GPS for your lungs.”

Desai was one of the initial interventional pulmonologists who worked with the robotic prototypes and helped develop some of the nuances it uses today. AMITA Health Alexian Brothers Medical Center in Elk Grove Village received the equipment about seven months ago, and since then, Desai and his team have completed approximately 60 procedures. Around 50 of those patients did have lung cancer, Desai says, and many went on to receive treatment.

“It has helped us get answers at a very high level of accuracy to detect patients with early lung cancer,” Desai says. “It has been a game changer.”

In a similar fashion, Desai and AMITA Health have been leaders in another recently developed treatment, this time for chronic obstructive pulmonary disease (COPD) and emphysema, which are characterized by the destruction of lung tissue.

A Zephyr Valve – a nonsurgical option approved in 2018 by the FDA – blocks off the diseased part of the lung, thus helping the healthier parts to function better and allowing the patient to breathe easier.

“For COPD and emphysema, the treatment options are typically inhalers and pulmonary rehab, and a lot of patients do well, but there are significant portions of the population that don’t feel better with just inhalers,” Desai says. “Lung transplant can be an option for patients, but it is very invasive, and patients can be waiting for a long time. A Zephyr Valve is an in-between, minimally invasive procedure.”

If inhalers or Zephyr Valves don’t work, Desai says there could be other options. He’s part of an international research trial for COPD that is evaluating Targeted Lung Denervation, a new investigational treatment that uses radiofrequency energy to the nerves outside the airways. It could potentially reduce the risk of COPD flare-ups through a one-time, non-surgical, outpatient procedure.

“Oftentimes, I think what happens is that primary care physicians and patients are unaware of these treatments,” Desai says. “There are always new things on the horizon.”

Treating Influenza

Common knowledge tells Midwesterners that flu season hits hardest in late fall or early winter, and most doctors recommend a flu shot to help ward off illness.

While vaccines are not new technology, the specific type of flu shot provided each year is, in fact, new – and for good reason.

Dr. Matthew Ivanovich

Influenza, or flu, is a highly variable viral infection, meaning it changes quite quickly, and it attacks the respiratory system. Vaccines are one of the best ways to fight the flu, but they’re not a one-and-done deal, says Dr. Matthew Ivanovich, head of the pulmonary division at Advocate Good Shepherd Hospital in Barrington.

“Once one has a vaccine, the immunity afforded by the vaccine is not long-term – you can measure its effectiveness in months,” Ivanovich says. “If a person had a vaccine last fall, coming up to this season, that vaccine won’t provide much in the way of protection.”

That’s why doctors recommend anyone 6 months or older (with some exceptions, like those with Guillain-Barré syndrome) be vaccinated each year by the end of October, before flu season begins in the northern hemisphere. That’s especially true for those older than 65 or those with medical issues like diabetes.

If you’ve missed the boat, don’t worry – and don’t wait until next year. Sometimes the flu will come late – March, April, even early May – Ivanovich says, so people can still get a flu shot and be protected.

When a person receives a flu vaccination, they’re actually receiving four vaccines in one, Ivanovich says. Two of them protect against the highly malleable Influenza A – one for last year’s strain and one for this year’s strain; and two others fight Influenza B strains, which change at a much slower rate, generally every two to four years.

Influenza vaccinations are taken very seriously by the global influenza community, Ivanovich says. The World Health Organization has an international program that tracks the migration of flu strains and identifies the new flu strain from season to season.

“There are medical departments in every single country whose sole purpose is to track and report on the various strains of flu,” Ivanovich says.

The Centers for Disease Control and Prevention puts out a weekly retrospective report that follows reported cases.

“There is definitely a lot of effort that is going into trying to predict where the flu is going next and what strain, because it is so shiftable,” Ivanovich says. “Antibodies we produce today and tomorrow are not going to be able to fight the next strain that comes out next year.”

There’s a difference between influenza and viruses like smallpox, Ivanovich points out. Smallpox was eradicated because it did not mutate. Once people were vaccinated, the virus was unable to survive – it eventually ran out of unvaccinated hosts and died out.

Influenza, however, besides being able to mutate, can also infect swine, birds and other animals, and as long as people have close proximity with those animals, the virus can continue to transfer hosts, mutate and spread to others.

“There’s not going to be a magic silver bullet or an all-out effort to get complete eradication of influenza,” Ivanovich says. “However, the more people get vaccinated, the less likely the influenza will spread.”

The same protective measures that have been communicated throughout the current global pandemic can be effective against influenza, because both coronavirus and flu are airborne, droplet-spread diseases that can be transmitted up to 6 feet away.

“The actual number of influenza cases and hospitalizations dropped dramatically this year, close to 35 percent, but only with masking, hand-washing and not congregating in closed areas,” Ivanovich says. “So, those measures that were put in force for the current coronavirus had a secondary effect on the influenza. They do work.”

Those who do contract influenza and suffer from high fever, shaking, chills, headache, muscle ache, weakness, stuffy nose, cough or sore throat, should immediately contact their health care provider.

The antiviral medication oseltamivir, or Tamiflu, can dramatically reduce the severity of flu symptoms – but only if ingested orally within 48 hours of the onset of symptoms, Ivanovich says. After that initial time frame, it’s not helpful.

Influenza won’t be going away, so Ivanovich says it’s best to remain vigilant and up-to-date on vaccinations.

“It is quite common, and most people will get better with chicken noodle soup and Alka-Seltzer, but why chance it and why go through it?” he says.

Addressing Sleep Apnea

Sleep apnea affects a person’s breathing, but it’s actually not a respiratory disease; it’s a neuro-muscular disease in which a person’s breathing stops and starts repeatedly, says Dr. Benjamin Nager, of Northwestern Medicine.

However, there is an overlap syndrome, meaning some people who have respiratory diseases like chronic obstructive pulmonary disease (COPD) or emphysema may also have sleep apnea.

Sleep apnea is fairly common. It’s estimated that half of people older than 50 and 30 percent of those between 30 and 70 years old have sleep apnea, says Nager, who practices in Crystal Lake.

Dr. Benjamin Nager

Nager has been studying and treating sleep disorder medicine since the early 1990s, and much has changed since then.

“Early on, it was like a joke,” he recalls. “If one of the people in a relationship snored, it wasn’t their problem, it was their bed partner’s problem.”

After NFL star Reggie White died in 2004 of supposed untreated sleep apnea, however, things started to change.

“Oprah did a show on sleep apnea because he supposedly died of sleep apnea, and it wasn’t a joke anymore,” Nager says. “People started to take it more seriously. So, a lot of credit goes to Oprah … it’s gotten a lot better.”

The most common ailments with sleep apnea are snoring – which often is witnessed and reported by their partner – and being fatigued even after getting seven or eight hours of sleep, Nager says. Morning headaches or waking up to urinate a lot at night are also common symptoms.

However, in order to officially make a diagnosis of sleep apnea, a patient must stop breathing – or have very shallow breathing – at least five times an hour, Nager says.

If a patient stops breathing 5 to 15 times an hour, his or her sleep apnea is considered mild, Nager says. Stopping 15 to 30 times is considered moderate; anything above 30 is severe, or if oxygen levels drop to very low saturation levels, it could be considered severe.

The vast majority of people wind up in the mild to moderate range, and many cases can be treated with a Continuous Positive Airway Pressure, or CPAP, machine, which provides pressure to push air into the lungs. This is the most common treatment for sleep apnea. There’s also a BiPAP machine, which provides two air pressure settings: more air when a person breathes in and less when he or she breathes out.

The American Board of Sleep Dentistry recommends those with sleep apnea use an oral appliance, like a bite guard. A bite guard, made by a dentist, pulls the jaw forward, thereby pulling the tongue out of a patient’s throat.

“Snoring becomes less prominent, and the throat is less likely to collapse while sleeping,” Nager says. “I only refer people to dentists who are board certified in sleep dentistry.”

One of the most recent innovations, approved by the FDA in 2014, is a hypoglossal nerve stimulator, commonly known as Inspire.

The device looks much like a cardiac pacemaker and, similarly, is implanted in a person’s body to help monitor their breathing, Nager says.

“When it turns on, every time you inhale, it sends an electrical signal to your tongue that moves your tongue forward in your mouth,” Nager says. “It has a remote control, and you push the button when you get in bed to set the timer before the device starts working. While you’re sleeping, it turns itself on, and every time you inhale, your tongue moves forward.”

Finally, one more – slightly controversial – solution to sleep apnea is to rectify the problem during childhood.
“Pediatric dentists who treat small children are starting to be educated to look for anatomical features that put them at risk for sleep apnea when they’re older, like a high-arched palate on the roof of their mouth,” Nager says. “You can see these kids because they usually have tall, thin heads and narrowed faces.”

Rapid palatal expansion widens a child’s upper jaw and thereby opens up the nasal passages by making them wider, Nager says. If successful, such an intervention can prevent the child from having sleep apnea as an adult, Nager adds.

Rapid palatal expansion has been around for several years, but using it for sleep apnea is a relatively new idea, Nager says. It has to be completed before a child’s epiphyses, or growth plates, harden, which means taking such steps before a child hits puberty.

“To me, that’s what all medicine should be like,” Nager says. “In 30 years, you’re going to have a problem, but we can prevent it now.”