LEXINGTON Originally from Pakistan, Iram Nawaz, MD, attended medical school there before coming to the United States for her internal medicine residency at Long Island College Hospital. Her mentor there was a pulmonologist and they worked together on several projects. What did she learn? Well, you could say it took her breath away.
“Seeing how smoking affects people’s health and lungs fascinated me,” says Nawaz, who is a pulmonologist and critical care physician at CHI Saint Joseph Medical Group in Lexington. “I started learning that COPD (Chronic Obstructive Pulmonary Disease) is the third-leading cause of death after heart disease and cancer. I wanted to learn more and see if I could help people.”
Nawaz has been helping people ever since. She completed her fellowship in pulmonary and critical care medicine at SUNY Downstate Medical Center at University Hospital of Brooklyn. Then, she and her husband began looking for a good place to settle down with their children. They moved to Kentucky in 2013 where she practiced at Ephraim McDowell Regional Medical Center in Danville for six years before recently joining CHI Saint Joseph Medical Group at Saint Joseph East in Lexington.
With its high rate of smokers and a climate infamous for seasonal allergy sufferers, Central Kentucky offers no shortage of patients for Nawaz, who offers both inpatient and outpatient services. Nawaz says she mostly sees patients suffering from chronic lung disease. She also performs minor surgical procedures such as lung biopsies for cancer diagnosis. In the hospital, many of the patients she sees are in the ICU dealing with severe conditions such as cardiac arrest or severe pneumonia.
“My practice is very diverse and I like it that way,” Nawaz says, noting that most of her patients are between the ages of 35 and 85, evenly divided between male and female. She says the most common presentation is shortness of breath with the most common conditions being COPD, lung cancer, and other chronic lung diseases.
“COPD should be taken as seriously as other life-threatening diseases are.”— Iram Nawaz, MD, pulmonologist and critical care physician, CHI Saint Joseph Medical Group
Not surprisingly, Nawaz says that smoking is the primary contributing factor to the prevalence of COPD in her patients.
“If I see 20 patients a day, 18 of those would be people who have been smokers for a very long time,” she says, adding that environmental factors such as exposure to fumes, chemicals or pollutants can also cause COPD. “Unfortunately, they start smoking as teenagers and we are seeing much younger patients with COPD. It’s a serious disease and progresses with age. Their quality of life is compromised and lifespan is reduced. Nothing cures the disease. But we can help patients manage and maintain their quality of life.”
Proper Diagnosis is Key
Effective treatment starts with a proper diagnosis, which Nawaz says can be difficult. Conditions such as asthma and congestive heart failure can have symptoms that mimic COPD, but the treatments can differ for each. COPD causes inflammation of the airways, but smoking also causes damage to the air sacks. The damage done to the air sacks is irreversible. Asthma also causes inflammation in the airways but does not cause damage to the lungs.
“Not every shortness of breath is COPD,” Nawaz says. “I have seen many younger patients with no history of smoking labeled COPD without having any tests done. If we don’t diagnose them appropriately, we can’t manage them appropriately. COPD should be taken as seriously as other life-threatening diseases are.”
Fortunately, Nawaz says she has seen significant improvement in the treatment options for those with COPD. For instance, inhalers have long been the primary treatment option, but these are not your mom’s inhalers.
“We are still using those inhalers, but now they are coming in different forms, and patients have multiple choices which are easier to use,” Nawaz says. “They also come in nebulized form, which is much easier to use. For patients who have a more aggressive disease, now there is a medicine (Daliresp) taken in the form of a pill. It is used once a day and can help reduce their exacerbations and help them stay away from the hospital.”
New Treatment Options and Prevention
While there are no cures for COPD, Nawaz says managing the disease and its symptoms includes preventative measures such as flu and pneumonia vaccinations. As the disease progresses, additional treatment methods include pulmonary rehab, which is an eight-week program that teaches patients breathing exercises to improve their quality of life. Oxygen therapy also can assist advanced patients, and Nawaz notes that the advancement of portable devices carried in handbags or backpacks allows patients to continue to work and be more active.
A more recent treatment option that has demonstrated good results is endobronchial valve therapy, a minimally invasive procedure in which tiny bronchial valves, as small as pencil erasers, are put into the lungs.
“The more damaged part of the lung that is causing COPD is not really participating in the lung function. We can close that door and let the healthy lung work better,” Nawaz says. “The bronchial valves help people to exhale but not inhale the air in that area. Studies have shown it helps people to breathe better. They start seeing sudden improvement because the healthy lung is now more active.”
Nawaz, who anticipates Saint Joseph East offering the procedure in early 2020, says it is an outpatient procedure performed using a bronchoscope. The patient is anesthetized while the bronchoscope is inserted through the mouth to deploy the valve.
Smoking and Vaping Cause Lung Damage
While treatments can offer better quality of life for COPD sufferers, Nawaz is intent on addressing the predominant cause of COPD.
“Treatments have improved, but it’s unfortunate we are not making more progress on COPD because smoking is still a problem,” Nawaz says. She notes that while vaping can, in some cases, help someone stop smoking, it is not a recommended smoking cessation solution. “Vaping causes acute lung injury. A good percentage of my patients use e-cigarettes or vaping to quit smoking, so my recommendation is, if they are already vaping and can quit smoking within a few weeks, fine. But I do not recommend it on a long-term basis.”
Smoking, of course, creates health issues beyond COPD. It is also the leading cause of lung cancer. While efforts to improve chemotherapies and find cures continue, Nawaz notes that easier, more accurate diagnostic tools are already making a difference.
“Years ago we did not have any standardized tests for lung cancer screening,” says Nawaz, who frequently does biopsies on lung nodules. “Now, lung cancer screening is recommended for anybody between the ages of 55 and 75 who has smoked for about 30 years and quit within past 15 years. For those patients, we do an annual low-dose CT scan of the lungs, and if we find anything early, then we can decide if it needs to be biopsied or needs to be followed closely.”
Nawaz says that bronchoscopies allow physicians to get “a more accurate, efficient, and quicker reply” than the former practice of sending potential lung cancer patients to surgeons for biopsies.
“We are becoming less invasive and becoming more accurate with these kinds of diagnoses,” she says, noting that patients are much more willing to have the screening via the bronchoscopy versus the more invasive surgical procedure. “No one likes to have their chest cut open. That is the last resort now.”
Better diagnostics, better procedures, better outcomes. It’s not a cure, but it is a breath of fresh air.