Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole. And we have a panel for you today to highlight the Environmental Lung Disease Clinic at UAB Medicine. Joining me is Dr. Kevin Dsouza, he's a pulmonologist and an assistant professor; and Crystal Stephens, she's a nurse practitioner, and they're both with UAB Medicine.

Thank you both for joining us today. And Dr. Dsouza, I'd like to start with you. Can you give us a little history in Alabama of the coal mining industry and the prevalence of lung diseases resulting from environmental exposure?

Dr. Kevin Dsouza: Alabama has a pretty, you know, entrenched history in iron and steel and coal mining. And this has led to an increased prevalence of coal worker's pneumoconiosis, asbestosis, and other such diseases. And because of such a steep history in heavy industries, we have felt at UAB the need to start a clinic which addresses these concerns. This was the concept and the history behind us starting the Environmental Lung Disease Clinic at UAB.

Melanie Cole, MS: Well, Crystal, then tell us a little bit more about this new UAB Environmental Lung Disease Clinic, a niche clinic, offering screening, second opinions, treatments for patients with lung diseases. Tell us a little bit more about the clinic. And Dr. Dsouza just mentioned how it came about. Tell us a little bit about your team and what goes on at the clinic.

Crystal Stephens: The Environmental Lung Disease Clinic at UAB is designed to provide comprehensive evaluations for patients from the state of Alabama and really the Southeast region. We don't have such a clinic in our area that deals with the respiratory conditions that are related to these work exposures.

So, as Dr. Dsouza mentioned, we do have a very active coal mine population estimated to be around over 3,600 people. And that's active, so that doesn't include those that have retired or aged out of this particular occupation. And so, we partnered with two other attendings. There is Dr. Joseph Barney and Dr. Dhaval Raval, who will also be staffing the clinic. And the goal is just to provide comprehensive evaluations for those who have been exposed in either work or other environmental locations that could be home or workplace and geographic areas that really have this heightened risk, predominantly those that are within the coal mines.

Dr. Kevin Dsouza: And to that I would like to add that the facilities we offer are pulmonary function testing, chest x-rays, advanced high resolution CAT scans, cardiopulmonary exercise testing, and apart from a really detailed history, which delves into the environmental work of the patients who enter the clinic have had throughout their history, their work history, and this is what we would offer in the clinic.

Melanie Cole, MS: Dr. Dsouza, speak about some of the conditions that you see from this environmental exposure, and even if some of them are cancers and fibrosis. I mean, you're seeing a lot of this, yes?

Dr. Kevin Dsouza: That is true. So, we would start with coal miner's pneumoconiosis, asbestosis. So, coal miner's pneumoconiosis primarily affects people who've been in the coal mines, so working in the coal mines. And that could range from just obstructive lung disease to progressive massive fibrosis, where there is, as you mentioned, fibrosis in the lung. Some of these conditions could be pre malignant. That means they could lead to cancers, especially in people exposed to asbestos and related exposures. And hence, it's really important to establish oneself in a clinic of this kind and be monitored to detect and avoid progression of the disease as well as early interventions.

Melanie Cole, MS: Crystal, what sort of modalities are offered? Are they treated right there at the clinic? Do they have a multidisciplinary team available? Tell us a little bit about that.

Crystal Stephens: The new patient evaluations, once they come in, as Dr. Dsouza mentioned, they should expect a full workup, that does begin with a team-based approach, beginning with clinical prep for each patient. We do, in fact, use a very detailed work history as that's really one of the most important parts of their evaluation. And so, in addition to the pulmonary function testing, the imaging, we obviously utilize respiratory therapy. There are some patients who will go on to be referred to programs such as pulmonary rehab. We do consult with radiology and, you know, IP if necessary for anything that needs to happen in-house. We do physiologic testing, kind of the cardiac testing, the cardiopulmonary testing. And walk tests and things like that are to be performed in house. But I think it's important to note that if we do feel that a person has been diagnosed with one of these particular diseases, the treatment for most of them is supportive care and management. And , what we do in house is going to be utilized as a way to track progress, see if they're having exacerbations or improvements for things that are associated with their condition, but that we would expect to see them ideally just annually to surveil their health, but always will be available in the event that there's an acute issue with their condition.

Dr. Kevin Dsouza: And adding to what Crystal said, in-house, we also have, apart from interventional pulmonary, access to the lung transplant program. So if we feel that this is necessary, we are the only lung transplant center in Alabama, and patients would get referred to, a lung transplant program too.

Melanie Cole, MS (Host): Dr. D'Souza, what indications would patients present to their primary care provider with as far as concerning symptoms?

 Dr. Kevin Dsouza: For other providers, other physicians and advanced practice providers, if there's a work history related to shortness of breath, you know, in a particular work environment, we would like to see those patients. It goes without saying people have been exposed to asbestos, to mold, to mining work, heavy industry, steel industries, any kind of exposure of that sort would be potential patients to send to us.

Melanie Cole, MS: I think that's important, but I also think that it's really important to note, and Crystal, this question is for you, is there a way that patients can self-refer? And if so, how do they go about doing that? Because that's something that patients don't realize they can do.

Crystal Stephens: Right. That's very important that you mentioned that. Patients are able to self-refer to our clinic, they can call the UAB switchboard and be put through to the access center and have themselves referred as a patient to the Environmental Lung Disease Clinic. I think that we are in the process also of sending out letter to many of the providers within our county and touching counties in the state and we hope to expand that so that other providers in our area and beyond are aware of our services and that they can refer patients or they can share the information with patients themselves in order to refer themselves.

Melanie Cole, MS: Well, they can certainly listen to this podcast and find out this great information. Dr. Dsouza, last word to you. What would you like PCPs and listeners to know to educate them about the new Environmental Lung Disease Clinic at UAB Medicine and the importance of this clinic that you all have started?

Dr. Kevin Dsouza: It's important to know that the environment we live in is not benign and we have multiple environmental exposures, all of us. And especially in Alabama, it's important to know that work history is an important part of a medical evaluation. So for providers, primary care doctors, you know, it's important to pick on that, that patients might have shortness of breath and some of this might be related to work or the environment they live in, be it work, be it home where mold being a big player in that. Screen early, ask the questions early and refer early. That's what I would suggest.

Crystal Stephens: I'd also like to add, if I would, that in addition to what Dr. Dsouza mentioned, screening early and also screening often. I think it's key for the patients as well as the providers to know that these symptoms from coal worker's pneumoconiosis and other environmental toxicants don't necessarily fit the timeline of an acute onset. And so, people who have been chronically coughing with, you know, either sputum or without sputum production for many, many months or having progressive shortness of breath, these things sometimes don't fit the ideal timeline, which is why that work history from 10, 20 or more years ago is so important.

Melanie Cole, MS: Thank you both for joining us today. That was great information and really important for this clinic and for people to hear about it. Thank you again. And for more information about the Environmental Lung Disease Clinic at UAB Medicine, please visit our website at uabmedicine.org. That concludes this episode of UAB Medcast. I'm Melanie Cole. Thanks so much for joining us today.