Pulmonary Fibrosis and the UK HealthCare Interstitial Lung Disease Clinic
Dr. James McCormick and Debra Gleason explain Pulmonary Fibrosis, treatment options, and how UK Health can help.
Featured Speakers:
Debra Gleason, MSW, MSN is an Advanced Practice Nurse at UK HealthCare.
James McCormick, MD, FCCP | Debra Gleason, MSW, MSN, APRN, FNP-BC
Dr. James McCormick, MD is a Geriatric Medicine Specialist and has over 48 years of experience in the medical field. Dr. McCormick has more experience with Obstructive Lung Disease, Interstitial Lung Disease, and Sleep-disordered Breathing than other specialists in his area. He graduated from University of Connecticut School Medicine medical school in 1972.Debra Gleason, MSW, MSN is an Advanced Practice Nurse at UK HealthCare.
Transcription:
Pulmonary Fibrosis and the UK HealthCare Interstitial Lung Disease Clinic
Introduction: Another informational resource from UK Healthcare. This is UK HealthCast featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.
Melanie Cole: Welcome to UK HealthCast with the University of Kentucky Healthcare. I'm Melanie Cole, and today we're talking about pulmonary fibrosis and the UK Healthcare Interstitial Lung Disease Clinic. Joining me in this panel is Debra Gleason. She's an Internal Medicine and Pulmonary Advanced Practice Nurse at the Interstitial Lung Disease Clinic at UK Healthcare and Dr. James McCormick. He's a Pulmonary and Critical Care Physician at UK Healthcare. Thank you so much for joining us, both of you and Dr. McCormick, I'd like to start with you. Why don't you tell us what pulmonary fibrosis is and speak a little bit about how common this is? Tell us about the prevalence.
Dr. McCormick: Pulmonary fibrosis means a scarring that occurs in the lung. It can occur in a portion of the lung or throughout the lung. What we focus on are those persons who have fibrosis affecting both the lungs. Usually throughout both lungs, this is becoming more and more common. It is associated with a number of systemic diseases, such as rheumatological disorders, but it can also occur for unknown cause. And when that happens, we call it idiopathic the unknown cause forms of pulmonary fibrosis have been steadily increasing over the last 30 years in the United States and around the world. And the reason in part is that these are diseases of aging fibrosis in the lung when it occurs diffusely and in both lungs is much more common in older populations. And we in Kentucky are seeing more and more of this as well.
Host: Well, Dr. McCormick sticking with you for a second, are there certain risk factors you can point to other than age? Is there a genetic component? Is it environmental or lifestyle behavioral? Tell us a little bit about causes and risk factors.
Dr. McCormick: Yes. One of the major risk factors is cigarette smoking, which is more common in people with fibrosis than in people who don't have it. And it can occur also as part of an occupational illness persons who work with asbestos or in coal mines, persons who work in environments, where they're exposed to a lot of chemicals or sprays. Farmers may have more prevalence of pulmonary fibrosis, for example. And then as I mentioned earlier, there are these idiopathic forms of unknown cause uncertain reason for their presence in an individual. And these are associated with aging. They're also associated with some family and genetic abnormalities or mutations.
Host: Well then Debra, can you tell us a little bit about your program at UK healthcare? Why did you see a need for this type of program? Tell us a little bit about it. What types of services you offer? Give us a kind a summary of it.
Debra Gleason: As Dr. McCormick mentioned, pulmonary fibrosis is a disease process that we have seen increased prevalence in. University of Kentucky Healthcare decided that this was a population that really had a lot of unmet needs, especially since Eastern Kentucky and part of West Virginia has a large population of farmers and coal miners. Those people that are at higher risk for pulmonary fibrosis and decided to dedicate part of their pulmonary clinic as a clinic where people who have interstitial lung disease can come and get some specialized care. So we have a group of providers, myself, Dr. McCormick. And then we also have Dr. Sage Chavonne, who are the providers in the clinic that see patients, new patients, maybe that don't live in the general Lexington area that come from out of State or from anywhere in Kentucky and see them as a initial consult and then try to develop a treatment plan and do a lot of diagnostic testing so that we can help these people provide them whatever treatment options that we have available. Two of the things that are unique to our clinic, at least in our area is that we offer a palliative care component. I have a background in palliative care. So I work with a lot of people on the terminal illness of pulmonary fibrosis, and then also helping them with symptom management and then also helping people look at possible research projects that they may be eligible for.
Dr. McCormick: I'd like to add to that, because we had such an interest and we have more and more patients with fibrosis in the lungs we applied for and received a designation from the Pulmonary Fibrosis Foundation as one of the regional centers to manage this disorder.
Host: Thank you both for that. And Dr. McCormick, speak to us a little bit about diagnosis. Why is it sometimes challenging to diagnose? Is it all pretty standard? Are all pulmonary fibrosis the same? Tell us a little bit about complications and diagnosis.
Dr. McCormick: Yes. The typical patient will present with shortness of breath or cough, that's not fully explained and may go on for some period of time before coming to the attention of a physician that usually leads to a physical examination, which may disclose some abnormalities. And then x-rays which identify pulmonary fibrosis typically. That leads to a referral to our center, where we have a specially trained radiologist who can identify the various forms of pulmonary fibrosis for us. And we perform special pulmonary function testing to decide whether or not the patient has some impairment in lung function, leading to their symptoms. After that, we do some blood tests. We may ask a patient to undergo biopsy. We can identify the exact type of pulmonary disease the person has. And then that could lead to a variety of therapies. We work closely together with physicians from other disciplines. And I'd like to ask Debra, if you could tell us more about the interdisciplinary approach we have in some of the therapies we offer.
Debra Gleason: Certainly, we have a multidisciplinary team that includes not only providers, radiologists, pathologists, providers from other disciplines, such as rheumatology, pulmonary rehab, transplant. We have a full time pharmacist and we all get together and discuss cases. It's been shown in the research that a multidisciplinary approach to pulmonary fibrosis is beneficial, not only for clinicians, but also for patients. It's an opportunity to get different points of view and put together a treatment plan that would be most effective for the patient.
Host: Then Debra, and thank you for telling us about the multidisciplinary team and why that's so important for these patients. Tell us about some of the therapies that you do have available. Are there any exciting breakthroughs you want to talk about? Tell us what you do with these patients?
Debra Gleason: Unfortunately, pulmonary fibrosis is a terminal disease in the sense that we don't have any treatments out there that are going to cure the individual of the fibrosis. So our focus is really on symptom management and providing those options that may stabilize the disease and hinder the progression of it. So right now we utilize two drugs named Ofev and Esbriet, those are drugs that hopefully will slow down the progression of the fibrosis. We offer those to patients with certain criteria and we follow them closely to manage side effects and the effects of the medications. We also encourage all of our patients to participate in pulmonary rehab. We've seen some tremendous results on people attending pulmonary rehab and being able to increase their activity tolerance and manage their symptoms much better. So with the pulmonary rehab and the, what we call antifibrotics, those are two treatments. There's also obviously other medications that may help with other specific aspects of the disease that we work with rheumatology, and then also we refer lots of patients to transplant.
Dr. McCormick: I would like to just mention what pulmonary rehabilitation is. It's a program of exercise and education that takes place over a period of weeks that improves patients' quality of life. It's been shown to improve quality of life and exercise capacity, and reduce shortness breath in patients with chronic lung disease like pulmonary fibrosis.
Host: What a great program and Dr. McCormick are these treatments expensive. Tell us a little bit about that. And is there financial help for treatments for the community?
Dr. McCormick: The treatments for these kinds of diseases can be quite expensive, but most insurances will cover them. And what isn't covered for the newer drugs that Debra mentioned that are used to prolong the course or reduce the progression of pulmonary fibrosis when people can't afford them, the pharmaceutical companies generally take care of it so that everyone has access.
Host: Debra, tell us where the clinics located and how appointments are made.
Debra Gleason: So, the clinic is located in Lexington, in the Kentucky Clinic Building, which is located at seven 40 South Limestone. We are on the second floor and people can call to inquire about the clinic or make referrals. Providers can make referrals or patients can call for appointments at (859) 323-9555.
Host: So, Debra, why don't you wrap it up first for us, tell listeners what you'd like them to know about pulmonary fibrosis and the Interstitial Lung Disease Clinic at UK Healthcare, really what you'd like them to know about you and your staff and this multidisciplinary approach to help people with lung disease?
Debra Gleason: I'd like people to know that we are out there to help with this disease that has numerous symptom management issues. And we have a multidisciplinary team that really looks at the different aspects of the disease process and also the symptom management that we're offering these patients when appropriate palliative care to help with symptom management at home help with caregiver support. And that we are also looking to forge a path to participate in clinical research that may provide individuals more options for treatment for this disease that is quite devastating to not only the patient, but the family.
Host: Dr. McCormick, last word to you, wrap it up for us with lifestyle behavior, your best advice as a critical care and pulmonary physician, what you'd like listeners to know about possibly preventing it in the first place.
Dr. McCormick: I think one thing I'd like to stress is our holistic approach to evaluation and management of these patients. We meet with them and their families. We try to make sure all questions are answered to the best of our ability. We focus not only on identifying and treating the fibrosis, but also preventing illness in these patients. If they need referral to a cardiologist, we look at appropriate immunizations. We focus on their sleep patterns and whether or not they need help with that. We assess whether or not persons need oxygen and how much they might need and how it might help them. And we refer virtually everyone who has this modality in their hometown to a pulmonary rehabilitation center. When persons have other complaints, we make sure they see the appropriate specialists and we follow up with their primary care physicians to make sure that person knows what's going on with their patient
Host: What a wonderful service and clinic. Thank you both for joining us today. For more information on the Interstitial Lung Disease Clinic at UK Healthcare, you can call (859) 323-9555 or you can visit UK Healthcare at UKY.edu to make an appointment and get connected with one of our providers. That concludes this episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts. I'm Melanie Cole.
Pulmonary Fibrosis and the UK HealthCare Interstitial Lung Disease Clinic
Introduction: Another informational resource from UK Healthcare. This is UK HealthCast featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.
Melanie Cole: Welcome to UK HealthCast with the University of Kentucky Healthcare. I'm Melanie Cole, and today we're talking about pulmonary fibrosis and the UK Healthcare Interstitial Lung Disease Clinic. Joining me in this panel is Debra Gleason. She's an Internal Medicine and Pulmonary Advanced Practice Nurse at the Interstitial Lung Disease Clinic at UK Healthcare and Dr. James McCormick. He's a Pulmonary and Critical Care Physician at UK Healthcare. Thank you so much for joining us, both of you and Dr. McCormick, I'd like to start with you. Why don't you tell us what pulmonary fibrosis is and speak a little bit about how common this is? Tell us about the prevalence.
Dr. McCormick: Pulmonary fibrosis means a scarring that occurs in the lung. It can occur in a portion of the lung or throughout the lung. What we focus on are those persons who have fibrosis affecting both the lungs. Usually throughout both lungs, this is becoming more and more common. It is associated with a number of systemic diseases, such as rheumatological disorders, but it can also occur for unknown cause. And when that happens, we call it idiopathic the unknown cause forms of pulmonary fibrosis have been steadily increasing over the last 30 years in the United States and around the world. And the reason in part is that these are diseases of aging fibrosis in the lung when it occurs diffusely and in both lungs is much more common in older populations. And we in Kentucky are seeing more and more of this as well.
Host: Well, Dr. McCormick sticking with you for a second, are there certain risk factors you can point to other than age? Is there a genetic component? Is it environmental or lifestyle behavioral? Tell us a little bit about causes and risk factors.
Dr. McCormick: Yes. One of the major risk factors is cigarette smoking, which is more common in people with fibrosis than in people who don't have it. And it can occur also as part of an occupational illness persons who work with asbestos or in coal mines, persons who work in environments, where they're exposed to a lot of chemicals or sprays. Farmers may have more prevalence of pulmonary fibrosis, for example. And then as I mentioned earlier, there are these idiopathic forms of unknown cause uncertain reason for their presence in an individual. And these are associated with aging. They're also associated with some family and genetic abnormalities or mutations.
Host: Well then Debra, can you tell us a little bit about your program at UK healthcare? Why did you see a need for this type of program? Tell us a little bit about it. What types of services you offer? Give us a kind a summary of it.
Debra Gleason: As Dr. McCormick mentioned, pulmonary fibrosis is a disease process that we have seen increased prevalence in. University of Kentucky Healthcare decided that this was a population that really had a lot of unmet needs, especially since Eastern Kentucky and part of West Virginia has a large population of farmers and coal miners. Those people that are at higher risk for pulmonary fibrosis and decided to dedicate part of their pulmonary clinic as a clinic where people who have interstitial lung disease can come and get some specialized care. So we have a group of providers, myself, Dr. McCormick. And then we also have Dr. Sage Chavonne, who are the providers in the clinic that see patients, new patients, maybe that don't live in the general Lexington area that come from out of State or from anywhere in Kentucky and see them as a initial consult and then try to develop a treatment plan and do a lot of diagnostic testing so that we can help these people provide them whatever treatment options that we have available. Two of the things that are unique to our clinic, at least in our area is that we offer a palliative care component. I have a background in palliative care. So I work with a lot of people on the terminal illness of pulmonary fibrosis, and then also helping them with symptom management and then also helping people look at possible research projects that they may be eligible for.
Dr. McCormick: I'd like to add to that, because we had such an interest and we have more and more patients with fibrosis in the lungs we applied for and received a designation from the Pulmonary Fibrosis Foundation as one of the regional centers to manage this disorder.
Host: Thank you both for that. And Dr. McCormick, speak to us a little bit about diagnosis. Why is it sometimes challenging to diagnose? Is it all pretty standard? Are all pulmonary fibrosis the same? Tell us a little bit about complications and diagnosis.
Dr. McCormick: Yes. The typical patient will present with shortness of breath or cough, that's not fully explained and may go on for some period of time before coming to the attention of a physician that usually leads to a physical examination, which may disclose some abnormalities. And then x-rays which identify pulmonary fibrosis typically. That leads to a referral to our center, where we have a specially trained radiologist who can identify the various forms of pulmonary fibrosis for us. And we perform special pulmonary function testing to decide whether or not the patient has some impairment in lung function, leading to their symptoms. After that, we do some blood tests. We may ask a patient to undergo biopsy. We can identify the exact type of pulmonary disease the person has. And then that could lead to a variety of therapies. We work closely together with physicians from other disciplines. And I'd like to ask Debra, if you could tell us more about the interdisciplinary approach we have in some of the therapies we offer.
Debra Gleason: Certainly, we have a multidisciplinary team that includes not only providers, radiologists, pathologists, providers from other disciplines, such as rheumatology, pulmonary rehab, transplant. We have a full time pharmacist and we all get together and discuss cases. It's been shown in the research that a multidisciplinary approach to pulmonary fibrosis is beneficial, not only for clinicians, but also for patients. It's an opportunity to get different points of view and put together a treatment plan that would be most effective for the patient.
Host: Then Debra, and thank you for telling us about the multidisciplinary team and why that's so important for these patients. Tell us about some of the therapies that you do have available. Are there any exciting breakthroughs you want to talk about? Tell us what you do with these patients?
Debra Gleason: Unfortunately, pulmonary fibrosis is a terminal disease in the sense that we don't have any treatments out there that are going to cure the individual of the fibrosis. So our focus is really on symptom management and providing those options that may stabilize the disease and hinder the progression of it. So right now we utilize two drugs named Ofev and Esbriet, those are drugs that hopefully will slow down the progression of the fibrosis. We offer those to patients with certain criteria and we follow them closely to manage side effects and the effects of the medications. We also encourage all of our patients to participate in pulmonary rehab. We've seen some tremendous results on people attending pulmonary rehab and being able to increase their activity tolerance and manage their symptoms much better. So with the pulmonary rehab and the, what we call antifibrotics, those are two treatments. There's also obviously other medications that may help with other specific aspects of the disease that we work with rheumatology, and then also we refer lots of patients to transplant.
Dr. McCormick: I would like to just mention what pulmonary rehabilitation is. It's a program of exercise and education that takes place over a period of weeks that improves patients' quality of life. It's been shown to improve quality of life and exercise capacity, and reduce shortness breath in patients with chronic lung disease like pulmonary fibrosis.
Host: What a great program and Dr. McCormick are these treatments expensive. Tell us a little bit about that. And is there financial help for treatments for the community?
Dr. McCormick: The treatments for these kinds of diseases can be quite expensive, but most insurances will cover them. And what isn't covered for the newer drugs that Debra mentioned that are used to prolong the course or reduce the progression of pulmonary fibrosis when people can't afford them, the pharmaceutical companies generally take care of it so that everyone has access.
Host: Debra, tell us where the clinics located and how appointments are made.
Debra Gleason: So, the clinic is located in Lexington, in the Kentucky Clinic Building, which is located at seven 40 South Limestone. We are on the second floor and people can call to inquire about the clinic or make referrals. Providers can make referrals or patients can call for appointments at (859) 323-9555.
Host: So, Debra, why don't you wrap it up first for us, tell listeners what you'd like them to know about pulmonary fibrosis and the Interstitial Lung Disease Clinic at UK Healthcare, really what you'd like them to know about you and your staff and this multidisciplinary approach to help people with lung disease?
Debra Gleason: I'd like people to know that we are out there to help with this disease that has numerous symptom management issues. And we have a multidisciplinary team that really looks at the different aspects of the disease process and also the symptom management that we're offering these patients when appropriate palliative care to help with symptom management at home help with caregiver support. And that we are also looking to forge a path to participate in clinical research that may provide individuals more options for treatment for this disease that is quite devastating to not only the patient, but the family.
Host: Dr. McCormick, last word to you, wrap it up for us with lifestyle behavior, your best advice as a critical care and pulmonary physician, what you'd like listeners to know about possibly preventing it in the first place.
Dr. McCormick: I think one thing I'd like to stress is our holistic approach to evaluation and management of these patients. We meet with them and their families. We try to make sure all questions are answered to the best of our ability. We focus not only on identifying and treating the fibrosis, but also preventing illness in these patients. If they need referral to a cardiologist, we look at appropriate immunizations. We focus on their sleep patterns and whether or not they need help with that. We assess whether or not persons need oxygen and how much they might need and how it might help them. And we refer virtually everyone who has this modality in their hometown to a pulmonary rehabilitation center. When persons have other complaints, we make sure they see the appropriate specialists and we follow up with their primary care physicians to make sure that person knows what's going on with their patient
Host: What a wonderful service and clinic. Thank you both for joining us today. For more information on the Interstitial Lung Disease Clinic at UK Healthcare, you can call (859) 323-9555 or you can visit UK Healthcare at UKY.edu to make an appointment and get connected with one of our providers. That concludes this episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts. I'm Melanie Cole.