NEW MEDICATIONS

XOLAIR

Xolair is a new medicine used for persons with asthma and is useful if you have severe asthma triggered by allergy. In these people, there is a higher IgE level (immunoglobin that is responsible for allergy). This IgE ultimately causes histamine release and allergy symptoms. This new drug binds IgE preventing its action and blocks the allergy cascade.

Xolair is used in addition to other therapies already in place for allergy and asthma. Xolair can also be used as a supplement to traditional allergy desensitization shots. It is given at your doctor's office 1-2 times per month by injection. This injection is quite safe and helpful in decreasing the episodes of illness, making episodes less frequent and less severe. Eventually your usual medicines may be decreased.

If you have severe asthma and are on multiple medications, you may be a candidate for this medication. To qualify, you have to have documented allergies (by allergy testing), as well as elevated IgE level (determined by a simple blood test).

SPIRIVA

Sprivia is a new inhaler used for persons with Chronic Obstructive Lung Disease (COPD), including chronic bronchitis. This medicine is used as a long-term maintenance therapy to help your breathing, replacing your atrovent inhaler.

Sprivia is convenient, given once a day. The medicine comes as a capsule that is placed into an inhaler. The capsule is then broken while in the inhaler and the medicine is breathed in. The side effects are rare, but can include dry mouth.

ACTIMMUNE

Actimmune is a new medicine used for persons with Idiopathic Pulmonary Fibrosis (IPF) and Chronic Granulomatous Disease. Interferon gamma in the body works to stimulate the immune system. This medicine is interferon gamma in an injectible form.

Actimmune is an exciting drug for persons with IPF. IPF is a progressive lung disease where the body forms scar tissue in the lung. The cause has been identified as immune factors. This medicine stimulates the immune system, thus slowing progression of IPF. Prior to this medicine, IPF had been difficult to treat.

Actimmune is given by injection twice a week, and can be given at home. The most common side effect is a flu like syndrome, however side effects tend to improve the longer the medicine is used. Tylenol given prior to the injection can often help with side effects.

To qualify for treatment, IPF needs to be in its early stages. Ask your doctor if you qualify.

NEW PROCEDURES

FLUORESCENCE AND ULTRASOUND BRONCHOSCOPY

Bronchoscopy is a procedure where a pulmonologist takes a small flexible scope and looks into your lungs. It can be done in the office with mild sedation. The conventional bronchoscope looks at the anatomy in your airway, and can tell if there is a mass or abnormal tissue in the airway. It can take biopsies and other samples to help diagnose certain conditions. In persons who have severe lung disease, the scope can help get harmful secretions out of the lung.

Fluorescence bronchoscopy uses a similar scope to look into the airway. However, there is a different light source on the end of the scope. This new light can also see early abnormalities in the airway, not yet seen by the naked eye. These abnormal cells absorb this fluorescent light differently than the normal airway tissue. Some precancer lesions may be detected earlier.

Ultrasound bronchoscopy is a small ultrasound at the end of a bronchoscope. The traditional bronchoscope sees lesions in the airway, but cannot detect if these lesions are just on the surface of the airway, or if they extend deep into the lung. The ultrasound can be placed on the lesion and can given an idea how deep the lesions extends into the lung.

The fluorescence bronchoscopy and the ultrasound bronchoscopy are new procedures in the developmental stages. Neither is readily available yet, but their use is anticipated to be more commonplace within the next few years.

LUNG TRANSPLANT

Am I a candidate for lung transplant? Types of diagnoses that may qualify for lungs transplant include:

-emphysema (including alpha-1 anti-trypsin deficiency)
-pulmonary fibrosis
-sarcoidosis
-bronchiectasis (immotile cilia, cystic fibrosis)
-pulmonary hypertension

Persons seeking transplant must meet certain guidelines. The transplant center will have their own guidelines, but in general, you may qualify for a transplant if you meet the following criteria:

-untreatable end stage pulmonary disease despite maximal medical therapy
-age greater than 18 or less than 65
-absence of other systemic infection or disease (no other chronic illnesses/ or cancer)
-no other organ system dysfunction
-life expectancy less than 2 years
-abstinence from tobacco, alcohol and other substances
-good rehabilitation potential
-good nutritional support status
-good social support
-evidence of healthcare compliance

What determines the need for a single lung transplant or double lung transplant?

An effective single lung can take the place of two bad lungs for most people. During a single lung transplant, one bad lung is replaced with a new, healthy lung. The remaining diseased lung is left in place.

In certain persons, a double lung transplant is needed. The diseased lung needs to be removed in order to protect the new healthy lung. Examples include bronchiectasis, or pulmonary hypertension.

New research has involved living donors for lung transplant. In this case, there would need to be two living donors, where a single lobe is taken from each donor.

Evaluation process is generally quite extensive. It involves a comprehensive medical exam and interview. The entire process can take up to one month to complete.

If accepted for lung transplant, you name will be placed on a waiting list. Persons on the waiting list are ranked according to numerous factors including time waiting and the urgency of their medical condition. The average wait time is about 19 months. There are more than 4,000 persons on lung transplant waiting list in the United States, however there are only 1,000 lungs available per year.

What do I need to know after transplant?

Early after transplant the most common complication is surgical. There is risk for wound infection as well as incomplete healing of the surgical site. Long term complications include rejection of the new lung as well as pneumonia.

To prevent rejection, you will have to take medicine the rest of your life. These medicines are called immunosuppresives, and are designed to prevent lung rejection. However, these medicines make the immune system "sleepy", making you at risk for infections including pneumonia.

Most persons suffer from some sort of rejection. Sometimes these episodes can be treated with corticosteroids (prednisone).

There are several centers in the United States that perform lung transplant. Barnes-Jewish Hospital in St. Louis, Missouri has an established program for lung surgery and transplant.

LUNG REDUCTION SURGERY

Some persons with emphysema develop large bullae (airbubbles) in their lungs (making their lungs look like swiss cheese). This diseased lung tissue takes up more space than does normal tissue. Lung reduction surgery involves removing 20-30 percent of diseased lung tissue, thus giving more room for the more normal lung tissue. This is not a cure, but is an alternative to lung transplant, and may help certain patients with emphysema. Ask your doctor if you would be a candidate.